Configuration Analyst

Summary

Join Abarca, a healthcare revolutionizing company, as a Configuration Analyst! You will be the primary support for plan configuration setups for various clients, performing unit testing, quality control, and issue resolution. Responsibilities include triage support, collaboration with other teams, and ensuring timely completion of tasks. You will maintain a deep understanding of the Darwin system and stay updated on regulatory guidelines. This role involves consultation, peer review, and process improvement contributions. The position offers a flexible hybrid work model.

Requirements

• Possess an Associate or bachelor’s degree. (In lieu of a degree, equivalent relevant work experience may be considered.)
• Have 3+ years of work-related experience in benefit plan configuration and/or implementations
• Have experience working with SQL and Excel tools
• Establish good interpersonal skills
• Demonstrate excellent oral and written communication skills
• Be available to work in a specified time zone or working schedule, accommodating the business needs of our clients and team members
• Be available 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)
• Be able to access and navigate each department at the organization’s facilities
• Be able to perform sedentary work that primarily involves sitting/standing

Responsibilities

• Provide primary support for on-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 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
• Take 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
• Track and monitor assigned requests daily 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

Preferred Qualifications

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

Benefits

Flexible hybrid work model (Puerto Rico Location Only)