Associate Quality Assurance Analyst

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 an Associate Configuration Analyst role, you’ll be responsible for the process plan configuration setup for new Medicare, Medicaid, Commercial and Employer client implementations as well as configuration changes for existing clients. You will verify and analyze operational situations and issues referred to for validations.

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.
• Perform unit testing to confirm configuration set-up or changes are processing as expected as defined in the client documentation.
• Perform research and resolution of adjudication and processing issues including, identification of root cause, impact analysis determination and corrective action.
• Apply appropriate sense of urgency support to other areas to verify and analyze claims processing cases, eligibility, and other operational situations and issues referred for validation within SLAs/SLOs.
• 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 an understanding of Darwin (proprietary adjudication platform) system logics to ensure benefit designs are configured to meet client requirements with accuracy.
• Make timely adjustments to operations ensuring our processes follow compliance, rules, and regulations of Medicare, Medicaid and State Requirements.
• Collaborate and coordinate with other business units to execute configuration as required.
• Provide feedback on processes and make recommendations for improvements.

Requirements:

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 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 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. 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.