Configuration Integration Analyst

Summary

Join Abarca, a healthcare revolutionizing company, as a Configuration Integration Analyst. You will be the primary support for managing the intake, validation, processing, and automation of configuration-related files supporting key automated processes. This role ensures seamless file handling, reduces manual interventions, enhances data integrity, and supports downstream adjudication processes. You will develop and maintain automation workflows, conduct quality checks, and collaborate with internal teams. The position requires proficiency in SQL, Macros, APIs, and Excel, along with excellent communication skills. A Bachelor's degree or equivalent experience is needed, and a flexible hybrid work model is offered.

Requirements

• Bachelor’s degree. (In lieu of a degree, equivalent relevant work experience may be considered.)
• 3+ years of work-related experience automated files configuration and/or implementations
• Proficient in SQL, Macros, APIs and Excel tools
• Ability to establish good interpersonal skills
• Excellent oral and written communication skills
• 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)
• Must be able to access and navigate each department at the organization’s facilities
• Sedentary work that primarily involves sitting/standing

Responsibilities

• Handle daily intake, validation, and processing of configuration files
• Develop and maintain automation workflows and transformation scripts
• Conduct quality checks, troubleshoot errors, and ensure adherence to mapping dependencies with Configuration and Formulary Leads
• Coordinate with internal teams to ensure timely file delivery and processing
• Monitor file automation performance and identify issues
• Maintain documentation, standard operating procedures (SOPs), and configuration mapping details
• Execute testing to confirm that automated file changes do not negatively impact adjudication results
• 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
• 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 file intakes are configured to accurately meet client requirements
• 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 needed to achieve client outcomes and collaborate with product and adjudication teams to plan and deliver appropriately
• Evaluate and analyze automated configuration processes and make recommendations for improvements
• Overseeing business sanity checks for pricing payments to ensure accuracy and compliance
• Conducting configuration checks across clients to maintain consistency and quality
• Leading the transition from configuration files to APIs, streamlining processes and enhancing integration
• Supporting and driving efficiency initiatives to optimize operations and resource utilization
• Implementing Robotic Process Automation (RPA) to automate repetitive tasks and workflows, further enhancing efficiency and accuracy

Preferred Qualifications

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

Benefits

Flexible hybrid work model which will require certain on-site work days (Puerto Rico Location Only)