Associate Quality Assurance Analyst

Abarca Health•San Juan, PR

7d•Hybrid

About The Position

Abarca is seeking to revolutionize healthcare through smarter technology, redefining pharmacy benefits. As an Associate Configuration Analyst, you will be responsible for setting up process plans for new Medicare, Medicaid, Commercial, and Employer client implementations, as well as managing configuration changes for existing clients. You will also be tasked with verifying and analyzing operational situations and issues that require validation.

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.

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.