Configuration Analyst

Abarca Health•San Juan, PR

4h•Hybrid

About The Position

As a Configuration Analyst at Abarca, you will provide primary support for plan configuration setups for Medicare, Medicaid, Commercial, and Employer client implementations, as well as configuration changes for existing clients. You will provide first-tier triage for operational issues and analyze configuration setup, claims processing, and other operational gaps to identify solutions. The role also involves ensuring configurations meet client requirements and applicable regulatory guidelines, supporting issue management and project work, and recommending process improvements.

Requirements

Associate or bachelor’s degree; equivalent relevant work experience may be considered in lieu of a degree.
At least 3 years of work-related experience in 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.
Availability to work in a specified time zone or schedule to accommodate the business needs of clients and team members.
May need to be available for on-call hours, including evenings, weekends, and holidays, to address emergent issues or provide support as operational demands dictate.

Nice To Haves

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

Responsibilities

Support plan configuration setup for new Medicare, Medicaid, Commercial, and Employer client implementations and configuration changes for existing clients.
Perform unit testing to confirm configuration setups or changes process as expected based on client documentation.
Perform Quality Control and Quality Assurance functions to assess accuracy across configuration processes.
Research and resolve adjudication and processing issues, including identifying root causes, determining impact, and implementing corrective action.
Own and resolve assigned project-based work.
Provide first-tier triage within SLAs/SLOs for pharmacy claims processing cases referred for validation.
Collaborate with configuration teams and other business units to execute required configuration work.
Track and monitor assigned requests daily to ensure due dates are met.
Support issue management workload through review, impact analysis, root cause assessment, and preventive measures.
Develop and maintain an in-depth understanding of Darwin system logic to configure benefit designs accurately according to client requirements.
Stay current with external regulator guidelines, including Medicare, Medicaid, and state requirements, and make timely operational adjustments to support compliance.
Provide consultation and peer review for configuration practices and design.
Identify functionality needed to achieve client outcomes and collaborate with product and adjudication teams on planning and delivery.
Support the Senior Analyst in documenting client plan standards.
Support development of process documentation, including policies and procedures, for Darwin Configuration operations.
Evaluate configuration processes and recommend improvements.