Configuration Analyst

Abarca Health•San Juan, PR

19h•Hybrid

About The Position

The Configuration Analyst provides primary support for plan configuration setups for Medicare, Medicaid, Commercial, and Employer client implementations, as well as configuration changes for existing clients. The role provides first-tier triage for operational issues, analyzes configuration and claims-processing problems, and identifies solutions to resolve operational gaps. The analyst performs configuration testing and quality checks, researches adjudication and processing issues, tracks assigned requests, and supports issue management. The role collaborates with configuration teams and other business units, develops an in-depth understanding of the Darwin proprietary adjudication platform, and keeps current with applicable regulator guidelines. The position also contributes to peer review, process documentation, improvement recommendations, and delivery of functionality that achieves client outcomes. Abarca offers a flexible hybrid work model requiring certain onsite workdays for the Puerto Rico location only. The position requires availability for a specified time zone or work schedule based on business needs. On-call availability, including evenings, weekends, and holidays, may be required to address emergent issues or provide operational support.

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.

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 and changes process as expected according to client documentation.
Perform quality control and quality assurance functions to assess the accuracy of information across configuration processes.
Research and resolve adjudication and processing issues, including identifying root causes, determining impacts, and taking corrective action.
Own and resolve assigned project-based work.
Provide first-tier triage within SLAs/SLOs by verifying and analyzing pharmacy claims processing cases referred for validation.
Collaborate within configuration teams and with other business units to execute configuration work.
Track and monitor assigned requests daily to ensure due dates are met.
Support issue-management work, including 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 Medicare, Medicaid, and state regulator guidelines 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 to plan and deliver it.
Support the Senior Analyst in documenting client plan standards.
Help develop process documentation, including policies and procedures, for Darwin configuration operations.
Evaluate configuration processes and recommend improvements.