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Clinical Call Center Representative

Pharmpix Guaynabo, PR

  • Posted: over a month ago
  • Full-Time
Job Description

This is your chance to unleash your full potential!


PharmPix, is currently seeking for qualified Clinical Call Center Representative candidate to join our team. We are looking for successful people like you. Join the fastest growing Pharmacy Benefit Management (PBM) company in its category and take your professional career to the next level. PharmPix has become a leading provider of pharmacy benefit solutions and services in the continental United States and the territories.


Our work philosophy is based on commitment, dedication and loyalty. We take care of our employees, just as we ensure the welfare of our clients and partners. If you are creative, service oriented, resourceful and visionary, we would like to hear from you.


Position Summary

This position will report to the Clinical Supervisor and will be responsible of the coverage determinations evaluations.

Essential Roles and Responsibilities

  • Constantly monitors the BACMAN Alert Application to ensure proper management of rejections at point of sale.
  • Change Alert status to approved or conditional denied when evaluations are completed.
  • Evaluate on an individual basis coverage determination to determine if the patient meets the criteria outlined in the guidelines or evaluation form and/or clients’ stipulations.
  • Forward, via email or as stipulated, to the clinical pharmacist the complete documentation if a prior authorization (including pharmacy edits) is conditional denied.
  • Prepare in a timely and accurate manner notification letters to members and prescribers, as stipulated by clients and/or PharmPix policy and procedures.
  • Notify members by phone any decision about coverage determinations.
  • Make outbound calls to pharmacies, providers and beneficiaries if necessary about coverage determination’s decisions as stipulated by clients and/or PharmPix policies and procedures.
  • Special projects and/or other duties assigned by the Clinical Manager and/or Clinical Supervisor.


Professional Experience and Skills Requirements:


  • Pharmacy Associate or Technical Degree.
  • Puerto Rico Board of Pharmacy Technician Registry Certificate.
  • One (1) – two (2) years of clinical experience (pharmacy determination) unit experience, preferred.
  • Skill in analyzing situations accurately and taking effective action.
  • Demonstrated effective organizational and communications skills.
  • Strong verbal and written communications skills.
  • PC skills (Microsoft System)/System oriented.
  • Fully bilingual: Spanish and English.


Additional Requirements:

The candidate must have:

  • 100% of the Covid-19 Vaccine.
  • Internet Accessibility with or more 10MB speed.
  • Must be able to work hybrid (on site and remote)

PharmPix is an Equal Employment Opportunity Employer Minorities / Females / Disable / Veterans




Guaynabo, PR
00968 USA



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