***Positions posted by El Comeback are done on behalf of companies that we support in their search for candidates.***

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

As a Configuration Analyst, you will be the primary support for plan configuration setups for Medicare, Medicaid, Commercial and Employer clients implementations, as well as configuration changes for existing clients.. You will provide first-tiertriage for operational issues, analyze, and identify solutions to resolve issues in configuration setup, claims processing and other operational gaps.

The fundamentals for the job

• Primary support for on plan configuration setup for new Medicare, Medicaid, Commercial and Employer client implementations, as well as configuration changes for existing clients.
• Perform unit testing to confirm configuration set-up or changes are processing as expected as defined in the client documentation.
• Perform Quality Control and Quality Assurance functions to assess information accuracy in all configuration processes,
• Perform research and resolution of adjudication and processing issues including, identification of root cause, impact analysis determination and corrective action.
• Resolution & Ownership of project-based work as assigned.
• Provide first-tier triage support within SLAs/SLOs to verify and analyze pharmacy claims processing case research referred for validation.

• Collaborate and coordinate both within the configuration teams and with other business units to execute configuration as required.
• Responsible for daily tracking and monitoring of assigned requests to ensure due dates are met
• Support the review, impact analysis, root cause assessment and preventive measures for issue management related workload.
• Continuously develop and maintain an in-depth understanding of Darwin (proprietary adjudication platform) system logics to ensure benefit designs are configured to meet client requirements with accuracy.
• Stay current with external regulator guidelines such as Medicare, Medicaid, and state requirements, to make timely adjustments to operations ensuring our processes follow compliance, rules, and regulations.
• Provide consultation and peer review for configuration practices and design.
• Identify functionality needed to achieve client outcomes and collaborate with product and adjudication teams to plan and deliver appropriately.
• Support the Sr. Analyst in documenting client plan standards.
• Support in development of process documentation, including Policies and Procedures, to document Darwin Configuration operational processes.
• Evaluate and analyze configuration processes and make recommendations for improvements.

What we expect of you

The bold requirements

• Associate or bachelors degree. (In lieu of a degree, equivalent relevant work experience may be considered.)
• 3+ years of work-related experience benefit plan configuration and/or implementations.
• Experience working with SQL and Excel tools.
• Ability to establish good interpersonal skills.
• Excellent oral and written communication skills.
• We are proud to offer a flexible hybrid work model which will require certain on-site work days (Puerto Rico Location Only).
• This position requires availability to work in a specified time zone, accommodating the business needs of our clients and team members based in the in the determined time zone.
• This position requires availability for on-call hours, including evenings, weekends, and holidays, to promptly address emergent issues or provide necessary support as dictated by operational demands.

Nice to haves

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

Physical requirements

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

***El Comeback is a non-profit program from ConPRmetidos that attracts and retains professional talent for Puerto Rico-based jobs. Register at elcomebackpr.org/registration-form to get matched with professional opportunities on the island.***