Configuration Analyst - Remote

Overview

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…

In Short

• 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

• 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).

Benefits

• Experience in a healthcare non-retail pharmacy setting.
• Experience related to Pharmacy Benefit Manager Operations, Member Services, Pharmacy Networks, Fulfillment, Call Center, and Medicare.