Abarca Health LLC

Job Description Job Description Description: 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 a Configuration Analyst, you will be the primary support for plan configuration setups for Medicare, Medicaid, Commercial and Employer clients implementations, as well as configuration changes for existing clients. You will provide first-tier triage for operational issues, analyze, and identify solutions to resolve issues in configuration setup, claims processing and other operational gaps. The fundamentals for the job Primary support for on plan configuration setup for new Medicare, Medicaid, Commercial and Employer client implementations, as well as configuration changes for existing clients. Perform unit testing to confirm configuration set-up or changes are processing as expected as defined in the client documentation. Perform Quality Control and Quality Assurance functions to assess information accuracy in all configuration processes, Perform research and resolution of adjudication and processing issues including, identification of root cause, impact analysis determination and corrective action. Resolution & Ownership of project-based work as assigned. Provide first-tier triage support within SLAs/SLOs to verify and analyze pharmacy claims processing case research referred for validation. Collaborate and coordinate both within the configuration teams and with other business units to execute configuration as required. Responsible for daily tracking and monitoring of assigned requests to ensure due dates are met. Support the review, impact analysis, root cause assessment and preventive measures for issue management related workload. Continuously develop and maintain an in-depth understanding of Darwin (proprietary adjudication platform) system logics to ensure benefit designs are configured to meet client requirements with accuracy. 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. Provide consultation and peer review for configuration practices and design. Identify functionality needed to achieve client outcomes and collaborate with product and adjudication teams to plan and deliver appropriately. Support the Sr. Analyst in documenting client plan standards. Support in development of process documentation, including Policies and Procedures, to document Darwin Configuration operational processes. Evaluate and analyze configuration processes and make recommendations for improvements. Requirements: What we expect of you The bold requirements Associate or bachelor's degree. (In lieu of a degree, equivalent relevant work experience may be considered.) 3+ years of work-related experience benefit plan configuration and/or implementations. Experience working with SQL and Excel tools. Ability to establish good interpersonal skills. Excellent oral and written communication skills. We are proud to offer a flexible hybrid work model which will require certain on-site work-days (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 in a healthcare non-retail pharmacy setting. Experience related to Pharmacy Benefit Manager Operations, Member Services, Pharmacy Networks, Fulfillment, Call Center, and Medicare. 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. 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.