Associate Configuration Analyst

What you'll do

In a few words...

Abarca is igniting a revolution in healthcare. We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning...

As an Associate Configuration Analyst role, you'll be responsible for implementing new and updating existing benefit plan setups for Medicare, Medicaid, Commercial and Employer clients. You will also review client configuration requests, identify, and define their needs and requirements, determine the best operational approach, and perform setup in the PBM system. The position also requires that you perform client configuration setup testing as well as QA functions such as moving all plan benefit design implementations and changes into a Production scenario to ensure proper and accurate configuration for claims processing and adjudication. Additionally, you will work hands on to overview operational issues, analyze and identify solutions to resolve issues in configuration setup, claims processing and other operational gaps, as well as identify process improvement opportunities to make plan configuration design setup more efficient.

The fundamentals for the job...

• Process plan configuration setup for new Medicare, Medicaid, Commercial and Employer client implementations, as well as configuration changes for existing clients.
• Monitor and analyze key data and procedures for proper claims processing and adjudication system functionality (i.e., eligibility management, configuration setup) for all clients.
• Perform Quality Control and Quality Assurance functions to assess information accuracy in all configuration processes, such as, but not limited to, benefits, formulary, and network.
• Provide timely support to other areas to verify and analyze claims processing cases, eligibility, and other operational situations and issues referred for validation.
• Support urgent adjudication and processing issues including doing research, analysis, identification of root cause, impact analysis determination and corrective action.
• Work cross-functionally to properly carry out changes, evaluate impact of new system requirements and assist in the design and execution of test scripts.
• Help gather proper and accurate documentation and data during internal and external audits related to the Company's PBM processes.
• Develop process documentation, including Policies and Procedures, to document Darwin Configuration operational processes.
• Stay current with external regulator guidelines such as Medicare, Medicaid, and state requirements, to make timely adjustments to operations ensuring our processes follow compliance, rules, and regulations.
• Perform client or prospect client facing to present demos around the PBM configuration platform.
• Evaluate and analyze Darwin Configuration process requirements to make recommendations for improvements.

What we expect of you

The bold requirements...

• Associate or bachelor's degree in Accounting, Finance, or related field. (In lieu of a degree, equivalent relevant work experience may be considered.)
• Experience utilizing dashboard tools, (e.g., Tableau, QVW, and Excel tools).
• 1+ years of work-related experience.
• Ability to apply critical thinking skills to manage responsibilities.
• Ability to manage presentations as needed.
• Excellent oral and written communication skills.
• We are proud to offer a flexible hybrid work model which will require certain on-site workdays (Puerto Rico Location Only).
• This position requires availability to work in a specified time zone or working schedule, accommodating the business needs of our clients and team members.
• This position may require availability for on-call hours, including evenings, weekends, and holidays, to promptly address emergent issues or provide necessary support as dictated by operational demands (if applicable).

Nice to haves...

• Experience related to PBM Operations, Member Services, Pharmacy Networks, Fulfillment, Call Center, and Medicare.
• 1+ years of experience in healthcare non-retail pharmacy setting.

Physical requirements...

• Must be able to access and navigate each department at the organization's facilities.
• Sedentary work that primarily involves sitting/standing.

At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca's workforce reflects the communities it serves. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify. "Applicant must be a United States' citizen or Permanent Resident. Abarca Health LLC does not sponsor employment visas at this time"

The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It's simply meant to give readers an idea of what the role entails.

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