Hybrid Configuration Analyst, Pharmacy-PBM

at Abarca Health

• Job title: Configuration Analyst, Pharmacy-PBM
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: Not specified
• Degree requirement: Bachelor's Degree
• Tech skills: SQL
• Location requirements: Hybrid, United States

About the role

• Configuration Analyst providing primary support for pharmacy plan configuration setups for clients. Analyzing and resolving issues in claims processing and operational gaps.

Responsibilities

• Primary support for on plan configuration setup for new Medicare, Medicaid, Commercial and Employer client implementations
• 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
• 2+ years of experience related to Pharmacy Benefit Manager Operations, Member Services, Pharmacy Networks, Fulfillment, Call Center, and Medicare
• Experience working with SQL and Excel tools
• Ability to establish good interpersonal skills
• 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 which will require certain on-site work days (Puerto Rico Location Only)