Formulary Analyst

Abarca Health•San Juan, PR

8d•Hybrid

About The Position

Abarca is seeking a Formulary Analyst to join their team and contribute to redefining pharmacy benefits through smarter technology. This role involves configuring and implementing formularies for Medicare, Commercial, and Employer clients, including handling complex setups and process changes. The position requires a strong understanding of PBM operations, excellent communication skills, and the ability to research and resolve claims processing issues. The analyst will also play a key role in quality assurance, client support, and staying current with regulatory guidelines.

Requirements

Associate or bachelor’s degree in a related field. (In lieu of a degree, equivalent, relevant work experience may be considered.)
3+ years of work-related experience in PBM industry and operations.
Pharmacy Technician accreditation as well as a current and active license.
Experience with group benefits, services, and programs.
Experience writing so requirements, expectations, results, and conclusions are read easily.
Experience with established PBM Technology Companies.
Experience applying professional presence and business acumen to effectively manage clients, prospects, partners, and vendors.
Experience with basic statistics and management reporting.
Excellent oral and written communication skills.
Flexible hybrid work model which will require certain on-site work-days (Puerto Rico Location Only).
Availability to work in a specified time zone or working schedule, accommodating the business needs of our clients and team members.
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 or coursework in expanded benefits and/or insurance industry.
Experience with Medicare Part D regulations.

Responsibilities

Execute standard and complex formulary setups for new Medicare, Commercial and Employer client implementations, and process changes for existing clients.
Perform unit testing to confirm configuration set-up or changes are processing as expected as defined in the client documentation.
Conduct design review of peers on the proposed build design and configuration peer review.
Perform Quality Control and Quality Assurance functions to assess information accuracy in all Formulary Management processes.
Participate as needed in UAT testing for product enhancement/updates to confirm operational/business user acceptance.
Perform research and resolution of adjudication and processing issues including, identification of root cause, impact analysis determination and corrective action.
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.
Perform consultations internally and externally on formulary design.
Assist in the review of pharmacy formulary audits from the PBMs and assist in any remediation.
Act as a client support resource while participating as a member of the formulary team.
Responsible for daily tracking and monitoring of assigned requests to ensure due dates are met.
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.
Identify functionality and design needed to achieve client outcomes and collaborate with product and adjudication teams to plan and deliver appropriately.
Understand and document system logics and processes, as well as create and conduct training on them.
Guide and mentor other team members to improve overall client relations and higher quality outcomes.
Author new or maintain knowledge articles related to formulary topics.
Support the Knowledge Accelerator team in creating content, as needed, for training on subject matter expertise and process.
Support with in-depth training new team members in configuration setup and standardized quality procedures.
Evaluate and analyze processes and make recommendations for improvements.