What you’ll do

In a few words…

Abarca is igniting a revolution in healthcare.  We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning…

Our Operational Performance team is #All-In on centralizing data to dive through and study as they work on improving operations at Abarca. The Performance Monitoring team has the metrics tracking down from OKRs to KPIs and proactively manages shortfalls to ensure we continuously set and reach the highest standards. That's why performance is part of their name as they help drive both scalability and efficiency across the board!

As our Service Level Analyst, you will play a critical role in monitoring, analyzing, and reporting on service level agreements (SLAs) to ensure the organization meets its commitments to customers and clients. This role involves data analysis, reporting, and collaboration with various teams to maintain high service quality and customer satisfaction.

The fundamentals for the job…

• Tracks that Performance Guarantees (PG) reports are produced for each customer service. Documents overall compliance of SLAs by client/area.
• Analyze data to identify trends, areas of improvement, and/ or opportunities to enhance service delivery.
• Performs gap analysis to highlight breaches of SLA targets, investigating reasons and recommending improvement actions to PG owners to prevent their recurrence (collaboration with Performance Oversight team). Triggers and collaborates with PG owners on Improvement Action Plan process once criteria are met.
• Monitors PG owners Improvement Action plan completion and results.
• Executes periodic process audits to ensure reporting methodology accuracy.
• Monitor adherence to client service level agreement by reviewing documentation supplied by operations and technology teams.
• Generate regular reports on service performance and SLA adherence.
• Maintain accurate records of SLAs, service metrics, and performance data.
• Ensure documentation is up-to-date and readily accessible.
• Assist in the implementation of service improvement initiatives and projects.
• Provide data-driven insights to support continuous service quality enhancements.
• Identify and report potential risks to SLA attainment.
• Collaborate on strategies to mitigate risks and ensure consistent service quality.
• Provide necessary data and reports needed for the Performance Guarantee committee.

What we expect of you 

The bold requirements…

• Bachelor’s or Master’s Degree in Business Administration, Science, or related field (In lieu of a degree, equivalent relevant experience may be considered.)
• 3+ years of experience in experience in contract and vendor management, corporate affairs and/or related fields.
• Experience and solid expertise in project planning, data management, data analysis, and reporting.
• Experience in leveraging excel for reporting and business analytics.
• Excellent oral and written communication skills.
• We are proud to offer a flexible hybrid work model which will require certain on-site workdays (Puerto Rico Location Only)

Nice to have….

• Experience with Experience with the Healthcare, Pharmacy, and Pharmacy Benefit Management industries, Medicare Part D, and CMS regulations.
• Experience with SQL Queries, PowerBi, Microsoft Visio and other visual documentation or analytics tools.

Physical requirements…

• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing.

At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves.  We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify.  “Applicant must be a United States’ citizen. Abarca Health LLC does not sponsor employment visas at this time”

The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.

#LI-JD1 #LI-REMOTE

What you’ll do

In a few words…

Abarca is igniting a revolution in healthcare.  We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning…

Our Sales and Business Development gurus are the welcoming heralds for any potential client! They're entrusted with developing the strategy operational relationships that are needed to extend our superior quality, processes, and aid to new beneficiaries. They handle everything related to marketing our value proposition, proposal management, emphasizing our broad line of products and supporting all services our potential clients are seeking. 

As Proposal Writer you will collect accurate and timely information that is relevant to bid specifications and platforms from the subject matter experts and will support proposal development in any way needed to meet on-time delivery. You can put your creative juices to good use making sure that proposals present Abarca in a manner that differentiates the company from the rest and clearly articulates our value proposition. We expect quality, on-time proposals that have a high degree of probability to make it to the final stages of selection.

The fundamentals for the job…

• Lead, coordinate, write and edit all delegated proposals from start to finish.
• Engage and collaborate with key Subject Matter Experts (SME’s) to produce and improve Abarca’s Proposal content to maximize the chances of delivering winning proposals.
• Edit and revise proposals according to feedback.
• Review products, services, and business ideas to package the content in a manner that persuades and influences prospects.
• Attend and lead meetings as needed to support successful execution of the proposal package.
• Maintain our library of response system and close out proposals in the system.
• Maintain and update any documentation and exhibits as necessary or required for the proposal.
• Follow company and department policies to maintain consistency in proposal writing and meet regulatory requirements.

What we expect of you

The bold requirements…

• Bachelor’s Degree or Master’s Degree in English, Journalism, Marketing, Pharmacy or Healthcare Administration. (In lieu of a degree, equivalent, relevant work experience may be considered).
• 3+ years of experience in pharmacy or proposal writing with a focus in managed care, healthcare, or pharmacy benefit management.
• Experience with project management, process improvement, and agile methodologies.
• Experience collaborating with multi-functional teams to develop a customer-specific proposal strategy.
• Experience creating new proposal text by meeting with subject matter experts or using reference documents.
• Experience with Salesforce
• Experience with Ombud or other Request for Proposal (RFP) software management tools 
• Excellent oral and written communication skills.

Nice to haves…

• Experience in pharmacy benefit management and commercial background.
• Experience and comfort with presentation and public speaking.
• Experience analyzing compliance-driven and technical documentation to determine customer requirements and understand complex customer issues within the public sector, or pharmacy areas.
• Bilingual fluency in English and Spanish.

Physical requirements…

• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing.

At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves.  We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

 Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify.  “Applicant must be a United States’ citizen. Abarca Health LLC does not sponsor employment visas at this time”

 The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.

#LI-AMBT #LI-REMOTE 

What you’ll do

In a few words…

Abarca is igniting a revolution in healthcare.  We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning…

Our Product Team is the steady bridge between clients and tech teams at Abarca. They lead us towards #PBMAwesome by brainstorming new innovations, improvements and scaling for our product and technology offerings! Attention to detail and observational skills are key in this team to ensure our products are fully functional and maintain quality. Our Product Owners and Managers also ensure all program specifications are correct, business requirements are properly established, and operating procedures are adjusted as needed.

Product Owners on our team leverage a keen attention to detail and sharp observational skills to understand our product and services as well as their histories and upcoming innovations. In this role, you’ll work through analysis of the business requirements and software development life cycle to prepare all things product related! We’ll also need you to help identify improvements for operating procedures, evaluate existing or propose road maps and prepare specifications while collaborating with clients, internal operations, and technology teams.

What you’ll do:

The fundamentals for the job…

• Be the subject matter expert for one to two product domains within Abarca.
• Create, update, enhance, or refine business requirements, user stories and acceptance criteria in an agile framework.
• Assist and partner with other Product Owners and Product Managers in solving business needs through collaborative product feature enhancements.
• Gather requirements with internal clients and technology teams to solve complex business needs and translate ideas into requirements.
• Work collaboratively with business partners, SMEs, Developers, and Testers to ensure a shared understanding of business requirements.
• Determine feasibility of business requirements and recommend changes to support business needs and processes.
• Assist in analyzing business solution options by evaluating current system processes and identify possible solution options for new functionality or modifications to existing functionality.
• Provide support of your product domain in research, analysis and troubleshooting related to your products.
• Provide input and engage in setting priorities to define a product roadmap working with other product owners and product managers.
• Understand the products that you own and how they interact upstream and downstream within the product ecosystem.
• Ensure that system solution options are thoroughly researched, analyzed, and documented.
• Develops acceptance criteria and leads User Acceptance Testing (UAT) efforts to ensure the product meets the needs of the business.
• Provide support to Applications Development through participation in Design Reviews.
• Project estimates and resource plans for systems solutions.

What we expect of you:

The bold requirements…

• Bachelor’s or Master’s Degree in a related area (In lieu of a degree, equivalent relevant work experience may be considered.)
• 3+ years of experience as a product owner, product analyst or in roles associated and/or collaborating with product management within an Agile SDLC environment
• Experience in client facing tasks, facilitating meetings, and setting priorities.
• Experience leveraging and utilize SQL, business intelligence and associated data analysis tools.
• Experience in developing roadmaps, managing product questions, vendor management, leading meetings and, developing technical product documentation.
• Experience collaborating an agile and scrum environment and with associated SDLC toolsets (example: DevOps, Jira, etc.).
• Experience developing and documenting acceptance criteria and user stories.
• Excellent oral and written communication skills.
• We are proud to offer a flexible hybrid work model which will require certain on-site workdays (Puerto Rico Location Only)

Nice to haves…

• Scrum Certified Product Owner or Product Strategy Product Owner certification preferred.
• Experience with project management and/or process improvement.
• Experience in market research and analysis as well as sales support within requests for proposal.
• Experience with business intelligence solutions to create ad-hoc queries & reports to support analysis.
• Experience with Healthcare, Pharmacy, and Pharmacy Benefit industries, Medicare Part D, and CMS regulations, NCPDPD standards and/or HIMSS.
• Experience UX and/or Human Centered Design.

Physical requirements…

• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing.

At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves.  We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify.  “Applicant must be a United States’ citizen. Abarca Health LLC does not sponsor employment visas at this time”

The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.

#LI-MH1 #LI-REMOTE

What you’ll do

In a few words…

Abarca is igniting a revolution in healthcare.  We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning…

Providing high quality services to clients and beneficiaries is at the core of what we do every day! The PBM Operations & Services team is the very heart of Abarca and meets that standard by running services from MTM, price eligibility, configurations, and beneficiary services to government services and beyond. Our GPS, (Government Programs & Services) teams handle direct contact, data transfers, issue management, auditing, and much more for any state or federal agencies as well as government led programs. No one else in this division can talk the talk and walk the walk on Medicare and Medicaid services like they can!

In the role of GPS Regulatory Communications Program Manager, you are responsible for ensuring written communications sent to external parties are generated accurately and timely according to regulatory requirements and client agreements, while meeting all the standards required for successful processing internally or by our mail vendor. You need to be knowledgeable about the regulatory requirements that apply to Member or Prescriber communications and the internal end-to-end process of each communication type, from letter template definition, batch generation, printing, and mailing, to validation.

The fundamentals for the job…

• Analyze, trend, and track written communications for all lines of business. Keep an inventory of the most current approved letter templates by topic and by client, with applicable requirements.
• Stay up to date with regulatory requirements and best practices pertaining to mailing timeliness and communication requirements.
• Ensure communications requirements are followed in accordance with policies and procedures as well as regulatory guidance.
• Engage directly with clients, auditors and vendors as a subject matter expert and strategic consultant.
• Develop tools to document and perform monitoring activities for determining if letters are compliant with regulatory requirements, accurate content, approved templates, and mailing timeliness.
• Work with areas to identify root cause of issues pertaining to letter processes and ensure any findings are promptly corrected and documented properly.
• Assist in issue management processes related to communications processes and/or vendor performance to ensure corrective actions are performed, including testing and ongoing monitoring.
• Manage relationship with print and mailing delegated entities to ensure compliance with SLA’s and contracted functions.
• Facilitate discussions related to changes that may impact file exchanges between Abarca’s technical team and print and mailing vendor(s).
• Participate and facilitate discussions related to change that may impact regulatory communications. Prepare and maintain process documentation supporting regulatory communication processes and logics for internal and external audiences.
• Develop internal and client training programs and cadence, facilitate execution.
• Engage directly with clients and leadership to develop, modify, and deliver dashboards and other required reporting as needed.
• Identify, quantify, and communicate areas of risk and develop corrective actions.
• Support creation of internal and external CAPs; oversee implementation of remediations, monitor efficacy of corrective actions.
• Collaborate with client implementation team as needed for process requirements gathering, configuration, E2E testing and go-live process.
• Prepare ad hoc analysis and other reports such as RFP responses, presentations, among others.

 What we expect of you 

The bold requirements…

• Bachelor’s Degree or Master’s Degree in a related field. (In lieu of a degree, equivalent relevant work experience may be considered.).
• 6+ years of experience within a similar role in government related programs.
• Experience the Healthcare industry (PBM, Pharmacy, Insurance, CMS plan audits).
• Experience working with PBM Operations, Medicare Part D, Auditing and Monitoring, CMS Program Audits & Protocols.
• Excellent writing skills with high levels of negotiating capabilities and proper presentation skills.
• Experience in vendor management.
• Excellent oral and written communication skills.

Nice to haves…

• Bilingual fluency in Spanish and English.

Physical requirements…

• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing.

At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves.  We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify.  “Applicant must be a United States’ citizen. Abarca Health LLC does not sponsor employment visas at this time”

The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.

#LI-JD1 #LI-REMOTE

What you’ll do

In a few words…

Abarca is igniting a revolution in healthcare.  We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning.

Abarca’s Government Program Services team takes charge by handling programs within Medicare Part D and Medicaid. Areas that GPS handles range from managing PDE accuracy by working rejects within compliant timeframes and file submissions for Encounters and Plan Finder. The team leverages their deep understanding of Medicare Part D & the Medicaid Market regulatory environment to support different business areas such as PBM Operations, Compliance, Benefit Configuration, Product Strategy, and Service Delivery. The GPS team aims to provide improvements in the development of new capabilities in support of government program compliance and audit readiness.

As a Supervisor, Prescription Data Event (PDE), you will play a crucial role in ensuring the accuracy and integrity of Prescription Drug Event (PDE) data, a critical component of Medicare Part D compliance. The successful candidate will oversee a team of analysts responsible for the day-to-day PDE processes and work collaboratively with cross-functional teams to maintain compliance with regulatory requirements.

The fundamentals for the job…

• Oversee timely and accurate submission of PDE data while adhering to compliance requirements and service level agreements.
• Ensure the reconciliation of PDE data to resolve any discrepancies in a timely manner.
• Monitor and report on PDE data quality metrics and compliance within customer and CMS guidelines.
• Communicate PDE-related issues and updates to relevant stakeholders.
• Identify opportunities to streamline PDE data submission processes and enhance data accuracy.
• Lead a team of PDE analysts providing guidance, mentorship, and support to ensure team success.
• Direct and manage incoming work for the analysts as well as providing support for clients and internal requests in the capacity of a subject matter expert.
• Set performance goals and conduct regular performance evaluations for team members.
• Foster a collaborative and positive work environment that encourages growth and development.
• Identify and resolve escalating issues and conflicts within the operation, project execution, or implementation.
• Stay up to date with Medicare Part D regulations and CMS guidance related to PDE processes and data reporting.
• Work closely with the Product and Analytics teams to implement system and reporting enhancements and improvements.
• Develop and update Standard Desktop Procedures (SDPs) related to PDE processes.
• Collaborate with cross-functional teams including pharmacy operations, finance, and analytics to ensure data accuracy and consistency.
• Participate in meetings and presentations related to PDE metrics and data reporting.
• Establish effective communication between all stakeholders.
• Assist team during the development and testing of operational and project deliverables.

What we expect of you 

The bold requirements…

• Bachelor's or Master’s Degree in healthcare administration, pharmacy, or a related field. Master's degree preferred. (In lieu of a degree, equivalent, relevant work experience may be considered.)
• 6+ years of experience in roles within a health plan, pharmacy benefit management and/or related areas.
• 2+ years in a supervisory or leadership role overseeing teams.
• Experience with Medicare Part D regulations and CMS guidelines.
• Experience with team management and development including task coordination, team building, and other management aspects.
• Experience data analysis and data reconciliation withing healthcare and/or pharmacy benefit management.
• Experience handling root cause analysis, problem solving and escalations of prescription drug events and other Medicare Part D program aspects.
• We are proud to offer a flexible hybrid work model which will require certain on-site workdays (Puerto Rico Location Only)

Physical requirements…

• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing.

At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves.  We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify.  “Applicant must be a United States’ citizen. Abarca Health LLC does not sponsor employment visas at this time”

The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.

#LI-JD1#LI-REMOTE 

What you’ll do

In a few words…

Abarca is igniting a revolution in healthcare.  We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning…

From overseeing the implementation of new clients, products, and services to managing client relationships for all our accounts, the Client Success Team focuses endlessly on looking for ways to satisfy every single client’s need! As part of the Implementation Team you’ll be ensuring that all implementation aspects regarding new clients, products and services are tracked and delivered.

As our Implementation Manager you will be responsible for adding new clients to Darwin (proprietary adjudication platform) based on the agreed-upon contractual obligations. You will manage the overall implementation, execution, and completion of the process while ensuring consistency with company strategy, commitments, and goals. You will serve as a primary point of contact for internal as well as external stakeholders and clients during the implementation phase of each project. This includes day-to-day interface on project commitments and updates, leading stakeholder, and client meetings, and ensuring project delivery is appropriate, timely, and accurate.

The fundamentals for the job…

• Oversee the effective, accurate, and timely transition of new clients into Darwin (proprietary adjudication platform).
• Establish implementation project plans, support, define, and gather requirements, outline project objectives, and define implementation success.
• Lead client communications and presentations throughout the implementation process, facilitate client meetings, maintain notes, and constantly assess progress against key milestones.
• Manage 1 or more small to medium-sized implementations.
• Proactively identify execution risks and develop solutions to address them.
• Coordinate and collaborate with internal and external subject matter experts (SME) to facilitate the gathering of requirements for a successful implementation.
• Provide excellent customer service and oversight to build and maintain trusting relationships with clients and any associated third parties.
• Support the development of internal implementation and project management best practices.
• Implementation teams will provide support during the stabilization period after going live for 45 days during the transition to operational support teams.
• Lead joint workgroup calls and clarification sessions to ensure prompt attention of issues or risks.
• Identify and resolve or escalate issues and conflicts within the project implementation.
• Lead site visits, conference calls, and related responsibilities to ensure requirements are gathered using a consultative approach.
• Participate in E2E testing to ensure that claims processing requirements documented in the requirements gathering are working accurately. If applicable, you must make sure any identified gaps get fixed.
• Manage and update implementation statuses as needed by providing weekly/monthly/quarterly progress reports to senior leadership and clients.

What we expect of you

The bold requirements…

• Bachelor’s degree or Master’s Degree in a related area. (In lieu of a degree, equivalent relevant experience may be considered.)
• 6+ years or more of applicable experience in client onboarding and implementations and/or client management.
• Demonstrated experience leading large teams and meeting schedule milestones for a large system implementation or transition.
• Experience balancing operational and client-facing tasks to ensure successful execution.
• Excellent oral and written communication skills.
• We are proud to offer a flexible hybrid work model which will require certain on-site workdays (Puerto Rico Location Only).

Nice to haves…

• Experience in Project Management or gathering business requirements.
• Experience within the PBM technology sector.
• Experience in insurance, pharmacy, and/or healthcare.
• Project Management Professional Certification.

Physical requirements…

• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing.

At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves.  We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify.  “Applicant must be a United States’ citizen. Abarca Health LLC does not sponsor employment visas at this time”

The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.

#LI-JD1 #LI-REMOTE

What you’ll do

In a few words…

Abarca is igniting a revolution in healthcare.  We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning…

The Legal & Compliance department ensures our business operations and processes are compliant with all state and federal requirements. They keep Abarca updated on all regulatory and legislative developments to mitigate the impact on the services we offer! They're also the team we go to for channeling services from our external legal counsel and working on matters related to tax, audits, managing codes of conduct as well as corporate, and healthcare law.

As Counsel for Regulatory Affairs, you will be responsible for the review, analysis and interpretation of legislation and regulatory sources, assessing the applicability and impact to Abarca, overseeing the cross-functional implementation of regulatory and legal requirements, working closely with operational business units to ensure understanding of these requirements, and determining any risks that may affect Abarca.

Thefundamentals for the job…

• Monitoring and tracking of state and federal legislative and regulatory measures impacting Abarca,
• Review, analyze and assess changes in state and federal laws and regulations, determining any risks or impact to Abarca, and coordinating with business areas to capture and document operational/system impacts and proposed solutions.
• Oversee the cross-functional implementation of legal and regulatory requirements, ensuring understanding of these requirements across business units and Abarca.
• Provide counsel on proposed legislation and regulations to impacted business units and clients.
• Assess regulatory and legal risks of any corporate initiatives and products.
• Draft responses to inquiries and consults presented by the business or clients regarding legal and regulatory requirements including but not limited to, federal legislation, Medicaid and Medicare legislation and guidance, state legislation applicable to the healthcare industry, or other state statutes or regulations where Abarca may be engaged in business.
• Collaborate with our Government & Industry Partnerships team on advocacy strategies for engaging with regulators and policymakers, preparing assessments of state and federal policy and legislative measures, providing amendments to proposed legislation impacting Abarca, and drafting position papers requested by State Legislature or others.
• Attend regulatory meetings (bi-weekly or as necessary) and coordinate with internal stakeholders on regulatory and legislative issues as they arise.
• When needed, lead stakeholder and industry related activities to coordinate initiatives related to legislation or matters impacting Abarca and/or the industry.
• Coordinate with clients’ internal legal counsel as needed for regulatory matters.
• Be up to date on applicable regulatory and legal requirements and be an educational source of knowledge and legal wisdom whenever needed.

What we expect of you

The bold requirements…

• Juris Doctor Degree from an accredited law school and licensed to practice law in at least one (1) state.
• 8+ years of experience with regulatory affairs, contractual or corporate compliance.
• Experience in healthcare industry, including managed care organizations, PBMs.
• Experience managing research and proficiency in regulatory sites and legal research systems (i.e. CMS, Westlaw, etc.).
• Excellent oral and written communication skills.
• We are proud to offer a flexible hybrid work model which will require certain on-site workdays (Puerto Rico Location Only)

Nice to haves…

• Experience with Medicare Operations and/or Part-D regulations.
• Be versed in California healthcare and industry regulatory and legal requirements.
• Experience in project planning and implementation.

Physical requirements…

• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing.

At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves.  We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify.  “Applicant must be a United States’ citizen. Abarca Health LLC does not sponsor employment visas at this time”

The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.

#LI-NO1 #LI-REMOTE

What you’ll do

In a few words…

Abarca is igniting a revolution in healthcare.  We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning…

As a Learning Designer, Knowledge Acceleration Team, you will be responsible for helping carry out the vision and mission of the Knowledge Acceleration Team to support PBM Operations and internal teams. Your expertise in learning experience and design will support internal associates by designing and delivering learning interactions though instructor-led training (ILT), online eLearning, microlearning, and off-road learning methods. In this role you will need to be versatile within learning methodology and PBM Operations.

The fundamentals for the job…

• Work independently and as part of a team to achieve optimal learning retention on claim adjudication systems and subsystems.
• Create and maintain training and documentation repositories such as training materials (e.g. PowerPoint, Articulate Rise, Participant Guides, Instructor Guides, and Job Aids), recordings, and other training documentation using Abarca’s enterprise learning, such as the learning management system (LMS), Knowledge portal, and SharePoint.
• Conduct interviews and demonstrations with various subject matter experts (SMEs) throughout the organization to gather required information or procedures.
• Stay up to date on changes to the adjudication platform, Abarca functional processes, and the pharmacy industry in general pertaining to PBM Operations, then maintain the training curriculum accordingly.
• Coordinate training sessions, focus groups, and feedback sessions following practices that ensure maximum attendance, participation, and learning.
• Utilizes various learning methodologies including SAM, ADDIE, Rapid Prototyping, and Agile Learning Design.
• Assist in the tracking of PBM Ops training records and the development of dashboard reporting.
• Stay in the know of advances in learning sciences and instructional design.

What we expect of you

Theboldrequirements…

• Bachelor's degree in a related area (In lieu of a degree, equivalent experience may be considered.)
• 3+ years of experience in roles related to the training development lifecycle (including but not limited to design, development, delivery, and evaluation).
• 2+ years of work-related experience in PBM industry or insurance industry.
• Experience and understanding of pharmacy benefit management lines of business including but not limited to operations as well as external regulator guidelines such as Medicare, Medicaid, and state requirements.
• Experience producing various types of documents such as end user guides, online help systems, quick reference guides, reference manuals, and functional specifications.
• Experience with Instructional Design and Multimedia tools.
• Excellent oral and written communication skills.
• We are proud to offer a flexible hybrid work model which will require certain on-site workdays (Puerto Rico Location Only).

Physical requirements…

• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing.

At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves.  We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify.  “Applicant must be a United States’ citizen. Abarca Health LLC does not sponsor employment visas at this time”

The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.

#LI-MH1 #LI-REMOTE

What you’ll do

In a few words…

Abarca is igniting a revolution in healthcare.  We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning…

Our Product Team is the steady bridge between clients and tech teams at Abarca. They lead us towards #PBMAwesome by brainstorming new innovations, improvements and scaling for our product and technology offerings! Attention to detail and observational skills are key in this team to ensure our products are fully functional and maintain quality. Our Product Owners and Managers also ensure all program specifications are correct, business requirements are properly established, and operating procedures are adjusted as needed.

Senior Product Owners on our team leverage a keen attention to detail and sharp observational skills to understand our product and services as well as their histories and upcoming innovations. In this role, you’ll work through analysis of the business requirements and software development life cycle to prepare all things product related! We’ll also need you to help identify improvements for operating procedures, evaluate existing or propose road maps and prepare specifications while collaborating with clients, internal operations, and technology teams.

The fundamentals for the job…

• Be the subject matter expert for one to two product domains within Abarca.
• Create, update, enhance, or refine business requirements, user stories and acceptance criteria in an agile framework.
• Assist and partner with other Product Owners and Product Managers in solving business needs through collaborative product feature enhancements.
• Gather requirements with internal clients and technology teams to solve complex business needs and translate ideas into requirements.
• Work collaboratively with business partners, SMEs, Developers, and Testers to ensure a shared understanding of business requirements.
• Determine feasibility of business requirements and recommend changes to support business needs and processes.
• Assist in analyzing business solution options by evaluating current system processes and identify possible solution options for new functionality or modifications to existing functionality.
• Provide support of your product domain in research, analysis and troubleshooting related to your products.
• Provide input and engage in setting priorities to define a product roadmap working with other product owners and product managers.
• Understand the products that you own and how they interact upstream and downstream within the product ecosystem.
• Ensure that system solution options are thoroughly researched, analyzed, and documented.
• Develops acceptance criteria and leads User Acceptance Testing (UAT) efforts to ensure the product meets the needs of the business.
• Provide support to Applications Development through participation in Design Reviews.
• Project estimates and resource plans for systems solutions.

What we expect of you

The bold requirements…

• Bachelor’s or Master’s Degree in a related area (In lieu of a degree, equivalent relevant work experience may be considered.)
• 6 + years of experience as a product owner, product analyst or in roles associated and/or collaborating with product management within an Agile SDLC environment
• Experience in project management, client facing tasks, facilitating meetings, and setting priorities.
• Experience leveraging and utilizing SQL, business intelligence and associated data analysis tools.
• Experience in developing roadmaps, managing product questions, vendor management, leading meetings and, developing technical product documentation.
• Experience in market research and analysis as well as sales support within requests for proposal.
• Experience in developing and documenting acceptance criteria and user stories.
• Experience in collaborating within an agile and scrum environment and with associated SDLC toolsets (example: DevOps, Jira, etc.).
• Excellent oral and written communication skills.
• We are proud to offer a flexible hybrid work model which will require certain on-site work days (Puerto Rico Location Only)

Nice to haves…

• Scrum Certified Product Owner or Product Strategy Product Owner certification preferred.
• Experience with business intelligence solutions to create ad-hoc queries & reports to support analysis.
• Experience Healthcare, Pharmacy, and Pharmacy Benefit industries, Medicare Part D, and CMS regulations, NCPDPD standards and/or HIMSS.
• Experience in UX and/or Human Centered Design.

Physical requirements…

• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing.

At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves.  We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify.  “Applicant must be a United States’ citizen. Abarca Health LLC does not sponsor employment visas at this time”

The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.

#LI-NO1 #LI-REMOTE

What you’ll do

In a few words…

Abarca is igniting a revolution in healthcare.  We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning…

As AVP, PBM Configuration Services you’ll be dedicated to supporting how we configure the platform for our clients. The Darwin Claims Operations team is responsible for initial set-up, quality, and maintenance of the benefit, pharmacy network, pricing, reprocessing and formulary design and system logic configurations as defined and documented by our clients. The AVP is responsible for leading and strategically managing all aspects of claims processing within the organization to ensure excellence at the point of service. Part of the job is to continuously evaluate processes to improve where possible, develop team members and their objectives, and establish metrics to measure the productivity and quality of your team.

The fundamentals for the job…

• Lead and manage teams of pharmacy benefit management (PBM) professionals within the configuration services department to deliver high quality.
• Collaborate with senior leadership to develop and execute long-term strategies for the growth and success of the configuration services department within Abarca.
• Serve as a subject matter expert on pharmacy benefit configuration processes and practices, representing the department in client meetings, industry conferences, and internal discussions.
• Formulates strategic initiatives and collaborates on the development of relevant OKRs (Objectives, Key Results), tracking the advancement of established objectives.
• Establishes and oversees the monitoring of key performance indicators (KPIs) to assess the efficacy and productivity of configuration services, instituting corrective measures as necessary.
• Stay abreast of industry developments, regulatory changes, and emerging technologies related to pharmacy benefit management, integrating relevant advancements into configuration practices.
• Provide leadership and mentorship to team members, fostering a culture of accountability, collaboration, and continuous improvement.
• Implements staffing strategies to cultivate a team of subject matter experts in the Darwin adjudication platform, Abarca’s ongoing expansion.
• Defines definitive product priorities for both external clients and internal stakeholders within the realms of configuration and adjudication.
• Serve as an integral part of the organization’s leadership team to help strategically plan for growth and develop ways to increase the optimal operational efficiencies and quality of claims processing at point of service.
• Collaborate with cross-functional teams to plan and execute projects and to deliver the highest quality of service for all clients and partners.
• Maintain a standard of continuous process improvement, including setting up the necessary control mechanisms for issue escalation.
• Ensure the configuration team remains current to any system changes or new functionalities that could impact compliance with CMS and state regulations and/or benefit design.
• Conduct performance reviews, quarterly/semi-annual check-ins, and staff meetings to guide performance management and employee development efforts and direct them toward departmental goals, including quality and process improvement efforts.
• Establish and cultivate teamwork, communication, and accountability.

What we expect of you:

The bold requirements…

• Bachelor’s Degree or master’s degree in business administration, Healthcare or a related area (in lieu of a degree equivalent experience can be considered).
• 12+ years of experience in a leadership role in the Pharmacy Benefit Manager industry.
• Experience with operations and external regulator guidelines (such as Medicare, Medicaid, and state requirements).
• Experience leading teams within the pharmacy claims management and configuration arenas.
• Experience with dashboard tools, such as Power BI and Excel tools.
• Experience with handling multiple projects at once in collaboration with internal and external stakeholders.
• Excellent verbal and written communication skills.
• We are proud to offer a flexible hybrid work model which will require certain on-site workdays (Puerto Rico Location Only).

Physical requirements…

• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing.

At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves.  We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify.  “Applicant must be a United States’ citizen. Abarca Health LLC does not sponsor employment visas at this time.”

The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.

 #LI-REMOTE #LI-LW1

What you’ll do

In a few words…

Abarca is igniting a revolution in healthcare.  We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning…

Our Infrastructure Operations team is critical for success at Abarca Health. They handle the days in and days out of the entire architecture of our systems from data processing to server updates and stability. The Information Security team's focus is to monitor, detect, investigate and respond to events that could lead to incidents. They are involved in planning and implementing preventative security measures and oversee the security operations, which includes protecting IT infrastructure, networks, data, edge devices and identify any exploitation, whether accidental or intentional.

The Security Engineer is a key member of the security team, which is instrumental in ensuring the security of our cloud infrastructure and protection of our sensitive data: PHI & PII data, per our information security policy. In this role, you shall help identify security gaps and drive remediation activities to close those gaps. You’ll play an integral role in defining and assessing the organization's security strategy, architecture, and practices as well as contributes to maturing the company's infrastructure security architecture and technology frameworks.

The fundamentals for the job…

• Drive security related initiatives including but not limited to the creation and maintenance of security policies, implementation of security procedures and controls, and monitoring in conformance to the policy.
• Deploy and manage applications to monitor cloud infrastructure security and intrusions.
• Perform initial incident triage, determine scope, urgency, and potential impact of security incidents.
• Provide guidance external auditors on compliance and to Engineering teams on security measures.
• Perform security gap assessments and implement remediations.
• Run periodic infrastructure vulnerability scans and pen testing and work with engineering teams on identified vulnerabilities for resolution.
• Collaborate with network and infrastructure teams on securing and best practices for all our Azure, IBM Cloud, and on premises environments, as well as OS hardening, access logging, and patching.
• Own the overall cloud infrastructure security program including driving incident response and resolution and adjust procedures as applicable.
• Monitor industry security updates, changes, technologies, emerging threats, and best practices for continuous improvement.

What we expect of you 

The bold requirements…

• Bachelors Degree or Master’s Degree in Computer Science, Information Security, or a related area. (In lieu of a degree, equivalent relevant experience may be considered.)
• 3+ years of experience in Infrastructure and Information Security.
• 3+ years working on Azure or AWS running multiple production workloads.
• Experience with OS hardening techniques for Windows environments.
• Experience with access logging, centralized logging, and monitoring/alerting of security log events.
• Experience with applications for monitoring infrastructure security and detecting intrusions.
• Experience designing and implementing access control models for privileged access in fast-paced cloud environments.
• Experience with incident response, threat modeling, and mitigation, as well as common information security management frameworks such as ISO27001.
• Experience with Azure security best practices and security controls using Azure services (AWS experience will be considered).
• Experience with common internet protocols such as DNS, DHCP, SMTP, LDAP, etc.
• Excellent oral and written communication skills.
• We are proud to offer a flexible hybrid work model which will require certain on-site work days (Puerto Rico Location Only)

Nice to haves…

• Security-related certification such as CISSP, CCSP, CEH, CISM, etc.
• Experience with HCI technology.
• Experience with OS hardening techniques for Linux.

Physical requirements…

• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing.

At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves.  We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify.  “Applicant must be a United States’ citizen. Abarca Health LLC does not sponsor employment visas at this time”

The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.

#LI-MH1 #LI-REMOTE

What you’ll do

In a few words…

Abarca is igniting a revolution in healthcare.  We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning…

Our Site Reliability Engineering team leverages software engineering and infrastructure operations to create highly reliable and scalable software systems. The team is responsible for ensuring that Abarca’s infrastructure operates efficiently by assisting with the design, build, and maintenance of software systems that automate and optimize the deployment, monitoring, and performance of Abarca’s systems. By focusing on improving the reliability and availability of software systems through engineering best practices and tools, we manage complex distributed systems to meet our external Service Level Agreements and internal Operating Level Agreements.

As our Site Reliability Engineer, you will be responsible for collaborating on the design, build, and maintenance of reliable and scalable infrastructure and software systems. This will be accomplished by tracking error budgets against service level agreements in order to meet and maintain compliance. You will also be collaborating with our Infrastructure, Software Engineering and Security teams to identify and implement reliability and performance improvements across our systems.

The fundamentals for the job…

• Manage error budgets while ensuring that service level agreements are being met while keeping our stakeholders satisfied and reducing penalties associated with performance issues.
• Monitor systems for potential performance and reliability issues, proactively taking measures to prevent their occurrence and minimize service disruption.
• Promptly troubleshoot and resolve production issues while also identifying opportunities for improvement in terms of reliability, to ensure timely resolution and mitigate future occurrences.
• Collaborate with Software Development, among other teams, continuously improving systems and processes to increase efficiency, minimize downtime, and optimize overall system reliability.
• Develop and maintain automation tools to improve system observability, reliability, and performance.
• Design and implement disaster recovery plans to ensure business continuity.

What we expect of you

The bold requirements…

• Bachelor’s or Master’s Degree in Information Technology, Computer Science or a related field. (In lieu of a degree equivalent experience may be considered).
• 3+ years of experience as a site reliability engineer or within related areas.
• Experience managing error budgets as well as service level agreements.
• Experience programming with, but not limited to: .Net, C#, JavaScript, PyScript, T-SQL/SQL.
• Experience with containerization technologies (e.g. Docker and Kubernetes).
• Experience with cloud infrastructure platforms (e.g. AWS, Azure, or GCP).
• Experience with monitoring and alerting tools (e.g. DataDog, AppDynamics, Dynatrace, Prometheus, SolarWinds, Grafana, or Nagios)
• Participate in on-call rotation to provide 24/7 support for critical systems. Availability to work rotating or irregular shifts, including weekends and certain holidays, per business or operational needs.
• Some travel required to Puerto Rico location 15-20%.
• Excellent oral and written communication skills.
• We are proud to offer a flexible hybrid work model which will require certain on-site work days (Puerto Rico Location Only)

Nice to haves…

• Experience with automation tools (e.g. Ansible, PowerShell scripting).
• Certified SRE Foundation (SREF).

Physical requirements…

• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing.

At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves.  We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify.  “Applicant must be a United States’ citizen. Abarca Health LLC does not sponsor employment visas at this time”

The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.

#LI-MH1 #LI-REMOTE

What you’ll do

In a few words…

Abarca is igniting a revolution in healthcare.  We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning…

Our Drug Value Strategy team manages day-to-day pharmacy network operations, developing standard reporting, crafting pricing and underwriting strategies. The Data Analytics teams drive the creation and management of standard reports for all Abarcans and clients to use! They work with raw data to supply updates for audits, create predictive models, and identify potential operational and clinical opportunities.

As our SQL Reporting Specialist you will analyze and report on all data lakes, files and tasks received. Reporting will be data-driven, and you’ll have the chance to present and collaborate with other departments for their needs by analyzing findings, troubleshooting developing, and guiding reporting storage. We’ll also rely on you to influence how we collect data, the design and layout of reporting, and recommendations on quality assurance management. Using that critical thinking and attention to detail will be important to ensure the accuracy and completeness of our data as well as proper use of associated analytics tools.

The fundamentals for the job…

• Translate requirements into reporting deliverables while also handling report and query development and testing.
• Create and analyze reports and share findings with end-users.
• Develop recommendations for modifications of existing reports or creation of new reports while also brainstorming processes for data collection, mining, standardization of reporting and analytics.
• Support implementations by handling the report side on the following areas: impact analysis reports, platform change monitoring reports, mitigation, and other related areas.
• Handle data management and support from the Analytics’ team while ensuring proper use of analytics tools.
• Combine business knowledge and technical expertise to assist customers in evaluating or addressing business issues through data.
• Assure project data integrity, including data extraction, storage, manipulation, processing, and analysis.
• Verify the completeness, timeliness, and accuracy of the output data.
• Work with business owners and technical resources to identify and address data quality issues as they arise.

What we expect of you

The bold requirements…

• Bachelor’s Degree or Master’s Degree in Computer Science, Engineering, or a related field. (In lieu of a degree, equivalent relevant work experience may be considered.)
• 1+ years of professional experience with SQL.
• Experience with designing, reporting, and delivering analytical solutions.
• Experience with business intelligence tools (i.e., Microsoft BI, Tableau, QlikView among others)
• Excellent oral and written communication skills, bilingual Fluency in Spanish and English is required for this role.
• We are proud to offer a flexible hybrid work model which will require certain on-site work days (Puerto Rico Location Only)

Nice to haves…

• Experience with healthcare utilization reporting, claims, membership, provider data, and standard Healthcare metrics.
• Proficiency with Reporting Services.

Physical requirements…

• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing.

At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves.  We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

 Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify.  “Applicant must be a United States’ citizen. Abarca Health LLC does not sponsor employment visas at this time”

 The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.

#LI-NO1 #LI-REMOTE

What you’ll do

In a few words…

Abarca is igniting a revolution in healthcare.  We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning…

From managing day-to-day pharmacy network operations, developing standard reporting, to crafting pricing and underwriting strategies, our Drug Value Strategy team has us going! Our Drug Pricing & Underwriting Strategy folks participate in client negotiations to establish rebates with key industry players while also creating attractive and lucrative pricing strategies and formulary recommendations for potential clients.

As part of our Network Strategy Provider Relations team, you will be responsible for assisting with the development and maintenance of the Provider Network and the related Pharmacy Service contracts and Agreements. You will work to ensure all our Provider Network Agreements are implemented correctly, and you will troubleshoot any network related issues for our clients and pharmacy partners. This role involves planning (i.e. pharmacy contracting), tracking, communication, and identifying and resolving issues. 

The fundamentals for the job…

• Assist with developing and maintaining pharmacy network strategies for US mainland and in Puerto Rico. Key inputs to consider type, location, and size of participating pharmacies, network size, reimbursement drivers and terms (discounts, DIR, incentives), quality criteria, and other contracting elements.
• Establish and maintain relationships with pharmacy chains and PSAOs, as well as national pharmacy organizations, i.e. NCPDP
• Serve as a point of contact for pharmacy operational questions and assist with pharmacy contracts, network maintenance, daily pharmacy enrollment requests and other relevant provider network tickets.
• Work with Legal team on creating and revising pharmacy contracting templates.
• Support and represent the development and execution of new clients, operationalize tasks associated, and deliver the highest quality of service to clients and pharmacies.
• Support the day-to-day tasks related to the pharmacy network, including triaging, and resolving issues, answering requests, creating and delivering reports on demand, and identifying opportunities for improvement.
• Use analytical tools to create and monitor network performance to ensure contract compliance and alignment with network objectives.
• Provide support to Client Engagement and Audit teams in Network related items such as directories, pharmacy education, member’s grievances, compliance, etc.
• Support Operations in the setup, configuration, and maintenance of pharmacy network requirements.
• Direct the proper storage and retention of all pharmacy documentation.
• Support day-to-day Provider Relations tasks.
• Organize and assist with pharmacy communications updates and tracking.

What we expect of you

The bold requirements…

• Bachelor’s Degree or Master’s Degree in a related field. (In lieu of a degree, equivalent relevant work experience may be considered)
• 3+ years of professional experience, preferably within a PBM or health plan.
• Experience with contract negotiation in PBM or a related industry.
• Experience with different payer types: Commercial, Employer Groups, Health Plans, Medicare Part D, Medicaid, 340B, Discount Card.
• Experience with Pharmacy types: Retail, Long Term Care, Home Infusion, Mail Order, Specialty, Institutions.
• Experience with Pharmacy Relationships: Chains, PSAOs, Independents.
• Excellent oral and written communication skills.
• We are proud to offer a flexible hybrid work model which will require certain on-site work days (Puerto Rico Location Only)

Nice to haves…

• Experience with analytics in terms of data tracking and analysis and project management tools.
• Experience in a Provider Relations, Chain Pharmacy, PSAO, Client Service, or a Relationship Management role.

Physical requirements…

• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing.

At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves.  We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify.  “Applicant must be a United States’ citizen. Abarca Health LLC does not sponsor employment visas at this time”

The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.

#LI-NS1 #LI-REMOTE

What you’ll do 

In a few words…

Abarca is igniting a revolution in healthcare.  We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning…

Safeguarding the financial health of our clients and Abarca is of the upmost importance! Our Finance team ensures that our financial systems are managed and running smoothly. Our rebates teams lead the way in all aspects of the manufacturer’s rebates contract interpretation, formulary compliance, system capabilities, billing, reconciliation, and allocation of payments for Medicare, Commercial, and Medicaid clients. In this role, you will focus on maintaining in-depth knowledge of our rebate processes, system improvements and compliance with contractual terms and regulations.

As Rebates Data & Reporting Analyst Lead you will analyze rebates invoices for manufacturing companies, contractual terms for billing, generate reconciliations and help designing tools to ensure the accuracy and completeness of data related to rebates billing cycle. The process will include reporting for external or internal users. You will also be supporting and collaborating in the new data management in a new repository. This role will also be providing full support of data element maintenance in the new reporting and analytics repository and help define new policies and procedures related to the collection and data accuracy, transformation of data to keep track of all rebates data flow in Abarca.

The fundamentals for the job…

• Continually collaborates with business and technology stakeholders to identify needs and opportunities for improved data and analytics solutions and delivery, business processes and tasks that can be automated, and to understand the underlying data resources and their relationship to deliver actionable data driven insights and decision support.
• Generate, review, analyze, and send out rebates reporting to external stakeholders, internal clients, manufacturer companies related to pharmacy and medical rebates for Commercial, Medicare and Medicaid line of business.
• Provide analytical support for rebates process management for all lines of business (3^rd party aggregator, In-House, MDRP and ASES).
• Ability to do research, investigate discrepancies, and propose as well as develop solutions.
• Perform complex root-cause analysis of issues identified in rebates reports. Gather necessary data to pinpoint problem areas on which to focus, validating that the analysis is data driven, recommending, and implementing solutions and evaluating those results, and implementing controls to monitor consistent use of the solution.
• Perform assessment and communicate critical information gathered by the reporting tools.
• Identify, analyze, and interpret trends or patterns in complex data sets.
• Assist in preparation of monthly management reports, accompanying schedules, worksheets and narratives, and quarterly and annual regulatory filings.
• Leads the development, construction, testing and maintenance of data architecture, extract, load, transform (ELT) processes, logical and physical data models, data marts, meta data repositories and database designs in alignment with business requirement.
• Fully support data modeling for new rebate data design in Snowflake.
• Identify manual processes that can be automated and take a lead role in developing processes to eliminate manual dependencies and incorporate necessary QA steps to minimize and identify errors.
• Participates in initiatives or projects that support process improvements, leveraging new system capabilities or the integration of data/other applications into existing systems.
• Support rebate information or modeling requests from clients; ad-hoc financial reports for clients and partners, as needed.
• Provide reporting as well as perform querying, testing, development, and validation of data.
• Provide full support to business and technical users regarding rebates process and develop complex QA processes to ensure data compliance with established procedures.
• Collaborates with rebates team and technical resources to identify and address data quality issues when they arise. Provide necessary supporting documentation of findings.
• Serve as liaison with technical area involved in the rebates processes to understand back-end process and how to apply it to data model and/or reporting.
• Support data integrity process, including data extraction, storage, manipulation, processing, and analysis; verify the completeness, timeliness, and accuracy of data; work with a variety of data files to ensure all rebate data is accurately loaded to the systems with proper support documentation.
• Track and document all requests, issues, deliverables to provide reporting and updates on a weekly basis to your manager and team.
• Interacts with internal and external members to accomplish goals. Communicate complex findings and conclusions in an easy-to-understand way, as well as ability to manage tight deadlines and competing priorities to ensure timely deliveries.
• Perform other duties and special projects as assigned. For example: support data modeling for new rebate data design in Snowflake and identifying trends and anomalies in loaded rebates data.
• May be responsible for training new team members as needed.

What we expect of you

The bold requirements… 

• Bachelor’s degree in computer science, engineering, or a related field. If you don’t have a degree, but you have the experience, we’ll consider you anyway.
• 5+ years of relevant work experience in PBM or pharmaceutical rebate management.
• 4+ years of professional experience with SQL and reporting tools (i.e., Snowflake, Microsoft BI, Tableau, QlikView).
• Experience in designing, reporting, and delivering analytical solutions.
• Experience managing complex reconciliation processes within financial and rebates areas.
• Experience leveraging tools for reporting and analytics (e.g. Excel, SSRS, PowerBI).
• Excellent oral and written communication skills, bilingual fluency in Spanish and English required.
• Must be located in Puerto Rico
• We are proud to offer a flexible hybrid work model which will require certain on-site work days (Puerto Rico Location Only)

Nice to haves…

• 2+ years of experience in a role within a financial field.
• Experience in healthcare industry, claims processing, Commercial, Medicare and Medicaid line of business and Pharmacy rebates, claims processing and data interchange.

Physical requirements…

• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing.

At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves.  We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify.  “Applicant must be a United States’ citizen. Abarca Health LLC does not sponsor employment visas at this time”

The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.

#LI-NS1 #LI-REMOTE

What you’ll do

In a few words…

Abarca is igniting a revolution in healthcare. We built our company on the belief that with smarter technology, we are redefining pharmacy benefits, but this is just the beginning…

Making healthcare awesome is key to everything we do at Abarca, and so the Strategy to Execution team helps us reach those heights through service design, project and process improvement, and strategy planning! From Project and Process Improvement to Innovation and Business Enabling to Strategic Management, this team tackles existing and innovative programs or processes at Abarca to rethink, reshape and rework how we do what we do.

As our Implementations Project Manager, you will manage multiple medium-sized projects or 1-3 highly complex and large-sized projects. You will have overall accountability for each assigned project and be responsible for project conception through completion, including scope, time, and budget, following our Project Management and Process Improvement methodology. You’ll be expected to document status, agreements and learnings from all meetings and presentations, and lead overall coordination, status reporting and stability of project work efforts.

The fundamentals for the job…

• In this role, you’ll be responsible for managing multiple medium-sized projects or 1-3 highly complex large-sized projects.
• You are to oversee overall coordination, status reporting and stability of project work efforts.
• You’ll establish and implement management processes and methodologies to ensure projects are delivered on time, within budget, adhere to high quality standards and meet expectations.
• You get to define the scope, develop plans, manage milestones, develop, and carry out appropriate communication plans with stakeholders; you also develop relationships with cross functional partners and align project timelines to ensure they are completed meeting stakeholder needs.
• Assemble project plans and teamwork assignments, direct and monitor work on a daily basis, identify resources needed, perform quality reviews, and escalate functional, quality, and timeline issues appropriately.
• Keep track of key milestones and adjust plans and/or resources to meet customer needs.
• Schedule and monitor project deliverables.
• Coordinate communication with all areas that impact the scope, budget, risk, and resources of the project.
• Manage and update project plan using Microsoft Project tool and keep team informed of status and deliverables.
• Provide weekly/monthly/quarterly progress reports to management, as needed.
• Provide oversight and leadership in executing projects from planning to completion to provide results to the business​.
• Assess, prioritize, and provide a health check report of active projects.
• Provide advice to optimize business performance and assist in the development of the department’s strategy​.
• Provide operational process improvements, identifying, analyzing & improving current business processes to optimize performance, meet best practices and improve quality.
• Work in tandem with other teams to automate processes, improve functionality, identify inefficiencies and areas for improvement, and drive advances that impact both, the team’s performance as well as the client expecting deliverables.
• Provide education, training and presentation of project updates, new processes, and tools for users.
• Be generally amazing and awesome to the point that people want to work projects of which you are in charge.
• Perform any other tasks or special projects as assigned.

What you’re made of 

The bold requirements…

• Bachelor or Master’s Degree Engineering, Business or Economics (In lieu of a degree, equivalent relevant experience may be considered.)
• 3+ years of experience in project management.
• Experience with data analytics tools (e.g. Excel, Tableau, Power BI)
• Experience leading cross-functional initiatives, driving performance, and executing on deliverables while leveraging tools and techniques.
• Experience in leveraging excellent communication to achieve commitment from stakeholders, good organizational skills for projects and problem-solving experience when issues arise.
• Excellent oral and written communication skills.
• We are proud to offer a flexible hybrid work model which will require certain on-site workdays (Puerto Rico Location Only)

Nice to haves…

• PMI Credential (PMP, PgMP, PMI-ACP, PMI-SP, or PMI-RMP).
• Experience with Microsoft Projects Server.
• Experience in health insurance or PBM setting managing projects.

Physical requirements…

• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing.

At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves.  We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify.  “Applicant must be a United States’ citizen. Abarca Health LLC does not sponsor employment visas at this time”

The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.

#LI-MH1 #LI-REMOTE

What you’ll do

In a few words…

Abarca is igniting a revolution in healthcare.  We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning…

Providing high quality services to clients and beneficiaries is at the core of what we do every day! The PBM Operations & Services team is the very heart of Abarca and meets that standard by running services from MTM, price eligibility, configurations, and beneficiary services to government services and beyond. Our GPS, (Government Programs & Services) teams handle direct contact, data transfers, issue management, auditing, and much more for any state or federal agencies as well as government led programs. No one else in this division can talk the talk and walk the walk on Medicare and Medicaid services like they can!

In the role of GPS Regulatory Communications Program Manager, you are responsible for ensuring written communications sent to external parties are generated accurately and timely according to regulatory requirements and client agreements, while meeting all the standards required for successful processing internally or by our mail vendor. You need to be knowledgeable about the regulatory requirements that apply to Member or Prescriber communications and the internal end-to-end process of each communication type, from letter template definition, batch generation, printing, and mailing, to validation.

The fundamentals for the job…

• Analyze, trend, and track written communications for all lines of business. Keep an inventory of the most current approved letter templates by topic and by client, with applicable requirements.
• Stay up to date with regulatory requirements and best practices pertaining to mailing timeliness and communication requirements.
• Ensure communications requirements are followed in accordance with policies and procedures as well as regulatory guidance.
• Engage directly with clients, auditors and vendors as a subject matter expert and strategic consultant.
• Develop tools to document and perform monitoring activities for determining if letters are compliant with regulatory requirements, accurate content, approved templates, and mailing timeliness.
• Work with areas to identify root cause of issues pertaining to letter processes and ensure any findings are promptly corrected and documented properly.
• Assist in issue management processes related to communications processes and/or vendor performance to ensure corrective actions are performed, including testing and ongoing monitoring.
• Manage relationship with print and mailing delegated entities to ensure compliance with SLA’s and contracted functions.
• Facilitate discussions related to changes that may impact file exchanges between Abarca’s technical team and print and mailing vendor(s).
• Participate and facilitate discussions related to change that may impact regulatory communications. Prepare and maintain process documentation supporting regulatory communication processes and logics for internal and external audiences.
• Develop internal and client training programs and cadence, facilitate execution.
• Engage directly with clients and leadership to develop, modify, and deliver dashboards and other required reporting as needed.
• Identify, quantify, and communicate areas of risk and develop corrective actions.
• Support creation of internal and external CAPs; oversee implementation of remediations, monitor efficacy of corrective actions.
• Collaborate with client implementation team as needed for process requirements gathering, configuration, E2E testing and go-live process.
• Prepare ad hoc analysis and other reports such as RFP responses, presentations, among others.

 What we expect of you 

The bold requirements…

• Bachelor’s Degree or Master’s Degree in a related field. (In lieu of a degree, equivalent relevant work experience may be considered.).
• 6+ years of experience within a similar role in government related programs.
• Experience the Healthcare industry (PBM, Pharmacy, Insurance, CMS plan audits).
• Experience working with PBM Operations, Medicare Part D, Auditing and Monitoring, CMS Program Audits & Protocols.
• Excellent writing skills with high levels of negotiating capabilities and proper presentation skills.
• Experience in vendor management.
• Excellent oral and written communication skills.

Nice to haves…

• Bilingual fluency in Spanish and English.

Physical requirements…

• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing.

At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves.  We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify.  “Applicant must be a United States’ citizen. Abarca Health LLC does not sponsor employment visas at this time”

The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.

#LI-JD1 #LI-REMOTE

What you’ll do 

In a few words… 

Abarca is igniting a revolution in healthcare.  We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning… 

Our Quality Assurance & Oversight team is key to implementing new clients, testing claims within their respective lines of business and ensuring all claims are paying out correctly. The Quality Assurance team ensures test cases and scripts are developed on the requirements clientshasspecified and while designing quality review processes with other departments. Along with them, the Product Quality team leverages these skills and functions by focusing on all Abarca related products and software services by collaborating with Product Teams.            

As ourSeniorProduct QualityAnalystyou will partner with the Product Team to ensure that business requirements originating from them are developed accurately and configured into our claims adjudication platform, while the Quality Assurance Analysts and Software Testers support the development and testing. You will execute all business functional testing activities to ensure the quality of each client’s pharmacy benefit design and that all new logic integrates with other plans’ programs. As such, understanding those requirements, designing, and defining testing scenarios, executingthemand documenting them will be an important aspect of your role. Due to the hands-onlevelyou will take on in this role, the team will support your developing knowledge of both technical and operational sides of the business as you make recommendations on corrective actions and process improvement for testing and monitoring. 

The fundamentals for the job… 

• Optimize testing and monitoring activities to ensure the quality of the systems and processes supporting the company’s operation. 
• Develop into a subject matter expert (SME) on certain lines of business and adjudication logic whilestaycurrent with regulatory guidelines. 
• Develop, document, and execute test plans, and test cases and scripts based on business functional requirements (independent of Software Test Engineer test plan). 
• Analyze, document, and report on test results to business stakeholders and SDLC teams. 
• Document and track issues identified during testing activities to ensure defect resolution and testing completion. 
• Perform functional testing of the specific adjudication changes being requested, their integration with the specific client rule being tested and related impact to other products. (e.g.member portal, platform visualization). 
• Review executed test results with Scrum team, business users, and requestors to ensure acceptance and approval of the results.
• Log all documentation of test plan execution and results in a centralized area available for all SDLC teams.
• Contribute to the business requirement gathering process by identifying missing requirements based on test-cases development and testing experience.
• Collaborate in the development of new ideas and requirements to resolve testing and system’s issues, and improve current systems based on testing results. Collaborate with the Software Test Engineering team to develop and improve testing strategies, techniques, procedures, and tools
• Participate in product grooming and refinement meetings to gather understanding of new system functionalities and requirements that will require testing and monitoring.
• Team up to support users during issue-solving activities, and day-to-day system operation. 

 What we expect of you 

The bold requirements…  

• Bachelor’s degreeorMaster’s Degreein Business, Engineering, Healthcare, or related field. (In lieu of a degree, equivalent relevant work experience may be considered.) 
• 6+yearsexperiencewithprogram testing (claims processing testing), quality assurance practices and tools. 
• Experience in pharmacy benefit manager (PBM) setting. 
• Experience as a detail-oriented problem-solver, able to quickly spot trends and discrepancies. 
• Experience analyzinglarge data sets while able to use dashboard tools (e.g.Tableau, QVW and Excel tools). 
• Experience leveragingstrong analytical and critical thinking bybeing,innovative, accountable and a team worker with a desire to be challenged. 
• Experience with Microsoft Office products (e.g.Excel, Power BI). 
• Excellent oral and written communication skills. 
• We are proud to offer a flexible hybrid work model which will require certain on-sitework days(Puerto Rico Location Only).  

Nice to haves…  

• Experience with software development life cycle (SDLC),quality assurance (QA)andSQL Management Studios. 
• Experience operational standards and processes for healthcare, pharmacy, pharmacy benefit management, Medicare Part D, and Centers for Medicare and Medicaid Services (CMS) regulations.  

Physical requirements… 

• Must be able to access and navigate each department at the organization’s facilities. 
• Sedentary work that primarily involves sitting/standing. 

At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves.  We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. 

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify.  “Applicant must be a United States’ citizen. Abarca Health LLC does not sponsor employment visas at thistime” 

The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails. 

 #LI-AMBT1 #LI-REMOTE 

What you’ll do

 In a few words…

 Abarca is igniting a revolution in healthcare.  We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning…

Providing high quality services to clients and beneficiaries is at the core of what we do every day! The PBM Operations & Services team is the very heart of Abarca and meets that standard by running services from MTM, price eligibility, configurations, and beneficiary services to government services and beyond. Our GPS, (Government Programs & Services) teams handle direct contact, data transfers, issue management, auditing, and much more for any state or federal agencies as well as government led programs. No one else in this division can talk the talk and walk the walk on Medicare and Medicaid services like they can!

As a Medicare Part B, Program Manager, you are the voice for key Government Programs, identified as the primary internal subject matter expert. You will have your finger on the pulse of critical programs and processes such as Part A and B pharmacy claims and coordination of benefits between Medicare and Medicaid. You will leverage your knowledge and experience to impact change. A Program Manager is energized by translating guidance into business processes and system requirements. You will also create and execute monitoring programs to ensure that CMS guidance is operationalized accurately and completely. In this role, you will employ your strong presentation and communication skills to work with other Abarcans and our clients to solve challenges and develop a better way. 

The fundamentals for the job…

• Serve as Medicare Part B expert for pharmacy claims with internal and external stakeholders for key programs and processes.
• Consultative related to other critical Part A and Part B process such like ESRD, Hospice, B vs.D
• Engage directly with PBM and health plan clients as a subject matter expert and strategic consultant.
• Develop strategic workplans to achieve the highest possible quality in implementing key initiatives.
• Assess regulatory guidance and technical specifications to build or guide processes that ensure accuracy.
• Develop and monitor key performance indicators for performance improvement initiatives.
• Analyze deviations from expected results; determine root causes and implement corrective actions.
• Establish effective oversight and monitoring programs to ensure all client and CMS requirements are met.
• Participate in and facilitate requirements discussions related to changes that directly impact programs in scope.
• Identify and define enhancements to the program processes and logics.
• Prepare and maintain detailed process documentation for internal and external audiences.
• Develop internal and client training programs and cadence, facilitate execution.
• Engage directly with clients and leadership to develop, modify, and deliver dashboards and other required reporting as needed.
• Identify, quantify, and communicate areas of risk and develop corrective actions.
• Support creation of internal and external CAPs; oversee implementation of remediations, monitor efficacy of corrective actions.
• Collaborate with client implementation team for process requirements gathering, configuration, E2E testing and go-live process.
• Prepare ad hoc analysis and other reports such as RFP responses, presentations, among others.

What we expect of you

The bold requirements…

• Bachelor’s or Master’s degree in a relevant area.
• 6+ years of experience in Medicare Parts B and D Operations.
• Detailed experience within Medicare Part B and coordination of benefits for pharmacy claims; specific knowledge of pricing and claim processes.
• Experience with coordination of benefits across different payers within healthcare, insurance and/or pharmacy operations.
• Experience organizing and leading cross functional team projects and initiatives.
• Experienced in employing creative thinking to identify challenges, ideate potential solutions, and lead others in implementing changes.
• Experience defining and communicating business requirements with technical and non-technical audiences.
• Experience employing strategic thinking and planning mindset.
• Highly organized and adaptable, able to work in a fast-paced environment.
• Excellent oral and written communication skills.  
• We are proud to offer a flexible hybrid work model which will require certain on-site work days (Puerto Rico Location Only)

Physical requirements…

• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing.

At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves.  We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify.  “Applicant must be a United States’ citizen. Abarca Health LLC does not sponsor employment visas at this time”

The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.

#LI-REMOTE #LI-JD1

What you’ll do

In a few words…

Abarca is igniting a revolution in healthcare.  We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning…

Providing high quality services to client and beneficiaries is at the core of what we do every day! The PBM Operations & Services team is the very heart of Abarca and meets that standard by running services from MTM, price eligibility, configurations, and beneficiary services to government services and beyond. Within this division, our Quality Assurance & Oversight team leads the charge in quality oversight, root cause analysis, findings and corrective actions regarding adjudications and pharmacy claims.

As our Quality Assurance Analyst, you’ll be the go-to person for answers and prompt solutions, guaranteeing high quality continues to distinguish our technological platforms. You will be responsible for performing tests and monitoring activities as part of projects, new client implementations and/or new functional requirements implementations, ensuring the quality of the systems and processes that support the company’s operation. You will be tasked with understanding business requirements and technical specifications, identifying, and defining testing scenarios, and creating, executing, and documenting test cases/scripts conducted to existing functionalities, as well as to new features and/or fixes deployed to our systems. You will work with other key functional areas to ensure the quality and integrity of business requirements testing and monitoring efforts. You will come up with best operational approaches to testing, serve as a second-tier triage when issues arise, and will save the day analyzing and identifying solutions to resolve testing issues.

The fundamentals for the job…

• Optimize and perform testing and monitoring activities to ensure the quality of the systems and processes supporting the company’s operation.
• Be an SME on all lines of business (Medicare, Medicaid, commercial, etc) and stay current with regulatory guidelines, ensuring testing complies with rules and regulations.
• Develop, document, and execute test plans, and test cases and/or scripts based on functional requirements.
• Analyze, document, and report on test results to business stakeholders, company leads or external clients.
• Document and track issues identified during testing activities to ensure defect resolution and testing completion.
• Identify missing requirements based on test-cases development and testing experience.
• Guide other QA Analysts as they learn what you already know and share the knowledge.
• Lead development of new ideas and requirements to resolve testing and system’s issues, and improve current systems based on testing results by collaborating within the department and outside the department.
• Design testing documentation templates and testing scope as required by new client implementations.
• Conduct peer reviews of testing results and documentation to ensure the quality of the work being provided to the client on an as need basis.
• Create the first draft of policies and procedures related to testing and quality activities and assist in the ongoing maintenance of said policies.
• Participate on projects and new client implementations to gather understanding on new system functionalities and requirements that will require testing and/or monitoring.
• Create and conduct training on system logics and/or processes and be the champion that the team goes to when they have questions.
• Guide team members during issue-solving activities, new business requirements gathering, and day-to-day system operation.
• Work cross-functionally to properly carry out changes and evaluate impact of new system requirements.
• Participate in Prioritization and/or Request Management Meetings to coordinate testing when new functionalities are implemented.
• Lead the way in tracking and reporting of key quality metrics to monitor testing efforts and results.
• Gather proper and accurate documentation and data during internal and external audits related to the Company’s PBM processes.
• Perform additional tasks or special projects as assigned.

What we expect of you

The bold requirements…

• Bachelor’s Degree or Master’s Degree in Business, Engineering, Healthcare, or related field. (In lieu of a degree, equivalent relevant work experience may be considered.)
• 3+ years of experience or equivalent in a health plan and pharmacy benefit management setting.
• Experience with testing methodologies, troubleshooting, root cause analysis, quality assurance practices and tools.
• Experience in analyzing large data sets through dashboard tools (e.g., Tableau, QVW and Excel tools).
• Excellent oral and written communication skills.
• 3+ year of previous experience in benefits configuration, benefits testing, configuration testing and implementation testing.
• We are proud to offer a flexible hybrid work model which will require certain on-site work days (Puerto Rico Location Only). 

Nice to haves…

• Experience with software development life cycle and quality assurance.
• Experience with pharmacy benefit management operational standards and processes, Medicare Part D, and CMS regulations.
• Experience in healthcare, as pharmacy technician and or in implementation testing.

Physical requirements…

• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing.

At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves.  We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify.  “Applicant must be a United States’ citizen. Abarca Health LLC does not sponsor employment visas at this time”

The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.

#LI-REMOTE #LI-NS1