Associate Configuration Analyst at Abarca Health managing configurations for Medicare, Medicaid, and Commercial clients while ensuring compliance and accuracy in operations.
Responsibilities
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
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 in benefit configuration, Medicare Part D.
Ability to apply critical thinking skills to manage responsibilities.
Ability to manage presentations as needed.
Excellent oral and written communication skills.
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
Flexible hybrid work model requiring certain on-site workdays (Puerto Rico Location Only)
Cyber Assurance Analyst responsible for DISA STIG compliance evaluations and security control validations. Collaborating with technical teams and maintaining cybersecurity standards at Kwajalein Atoll.
Junior ESG Analyst supporting research and analysis on ESG factors for sustainability - focused organizations. Collaborating on data analysis and stakeholder engagement to drive positive impact in solar industry.
Consumer Analyst supporting KeyBank’s Language Access Program ensuring equitable access to banking for clients with diverse language backgrounds. Manage translation workflows and enhance language resources across the enterprise.
Cyber Defense Analyst managing security incidents within Eversource's Security Operations Center. Overseeing compliance, incident response, and audits for information security across systems.
Senior Project Controls Analyst analyzing project data and guiding Power BI Analysts at Eversource. Responsible for monitoring project performance in the capital program across multiple departments.
Claims Verification Analyst role at Manulife ensuring integrity in health and dental claims processes. Involves auditing submissions and addressing fraud risks with stakeholders.
eDiscovery Analyst providing technical support to litigation teams at FBT Gibbons. Facilitating data management, compliance with legal requirements, and collaboration with project managers and technicians.
Lead Business Strategy Analyst at USAA collaborating with business leaders to enhance member service experiences. Utilizing analytics and strategic foresight to improve member satisfaction and value.
Factoring Analyst verifying client documentation, onboarding, and managing collections in banking sector. Requires 3 - 8 years of relevant experience and offers hybrid work schedule.
Corporate Analyst in a rotational program gaining experience in Product Management, Digital Marketing, and Analytics. Join Uline, a leading distributor in shipping and packaging materials, and fast - track your career.