Abarca Health

👥 501-1000 Information Technology Health Care💼 Private Company

Abarca Health is a company focused on healthcare solutions, specializing in regulatory compliance and data analytics within the eligibility domain.

Related companies:

🏢 Social Discovery Group

👥 501-1000 Venture Capital Finance Information Technology

Website LinkedIn Facebook Twitter

🏢 Luxury Presence

👥 501-1000💰 $19,200,000 Series B over 1 year agoSoftware Development

Website LinkedIn Email Facebook

🏢 Tabby

👥 501-1000💰 $200,000,000 Series D over 1 year agoFinancial Services

Website LinkedIn Facebook Twitter

Jobs at this company:

Apply

🔥 Configuration Analyst

Posted 12 days ago

🔍 Healthcare

🔧 Requirements

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.

💡 Responsibilities

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.

Posted 12 days ago

Apply

🔥 Associate Configuration Analyst

Posted 12 days ago

🔍 Healthcare

🔧 Requirements

Associate or Bachelor’s degree in Accounting, Finance, or related field.
Experience utilizing dashboard tools, (e.g., Tableau, QVW, and Excel tools).
1+ years of work-related experience.
Ability to apply critical thinking skills to manage responsibilities.
Ability to manage presentations as needed.
Excellent oral and written communication skills.

💡 Responsibilities

Process 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 research and resolution of adjudication and processing issues including, identification of root cause, impact analysis determination and corrective action.
Apply appropriate sense of urgency support to other areas to verify and analyze claims processing cases, eligibility, and other operational situations and issues referred for validation within SLAs/SLOs.
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 an understanding of Darwin (proprietary adjudication platform) system logics to ensure benefit designs are configured to meet client requirements with accuracy.
Make timely adjustments to operations ensuring our processes follow compliance, rules, and regulations of Medicare, Medicaid and State Requirements.
Collaborate and coordinate with other business units to execute configuration as required.
Provide feedback on processes and make recommendations for improvements.

Posted 12 days ago

Apply

🔥 Director, Configuration Operations

Posted about 1 month ago

📍 Puerto Rico

🧭 Full-Time

🔍 Healthcare

🔧 Requirements

Doctoral Degree in Pharmacy.
Current/Active Pharmacy License.
10+ years of experience in pharmacy benefit management and external regulator guidelines.
Experience in a leadership role overseeing teams and their development.
Ability to prioritize and manage multiple projects without missing deadlines.
Excellent oral and written communication skills.
Strong analytical and problem-solving abilities.

💡 Responsibilities

Oversee configuration operations teams, providing strategic direction and mentorship.
Establish and maintain long-term relationships with key clients.
Conduct high-level data analysis and present strategic recommendations.
Lead communication strategies for configuration options and client reporting.
Collaborate with internal departments for service delivery.
Conduct gap analysis for client requirements and provide insights.
Lead training programs on configuration tools for teams and clients.
Oversee post-implementation activities and ensure client satisfaction.
Propose enhancements for configuration processes and efficiency.
Lead UAT testing for product enhancements and ensure configuration validation.
Monitor team performance and manage quality standards.

LeadershipProject ManagementSQLData Analysis

Posted about 1 month ago

Apply