Operations Support Analyst

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 an Operations Support Analyst, you’ll be identifying, analyzing, documenting, and reporting, as applicable, issues (programming, compliance, among others) identified by the Company, Patients, or Clients that may impact client or members. You’ll also support the timely performance and completion of all issue management activities of the organization; specifically, conducting the investigation and documentation of the description, root cause, corrective actions, preventive measures, and reporting of claims processing issues. Expect to contribute and collaborate extensively with other key functional areas to ensure the quality and integrity of the claims processing system. You’ll make recommendations for corrective action and process improvements based on documentary and report reviews and ensure proper monitoring of post-corrective actions to avoid reoccurrence.

The fundamentals for the job…

• Contribute to the definition of strategic initiatives to improve issue management, processes, tools, and reporting capabilities.
• Contribute, develop and/or implement issue management activities such as defining policies & procedures, workflows, and training. Support and maintain comprehensive Issue Management documentation.
• Participate in the preparation for CMS, client or internal audits as well as follow through on any corrective actions requiring Issue Management Support
• Contribute to the implementation and continuous development of any systems and/or tools used to support Issue Management and Problem Management activities.
• Monitor Darwin RxEngine and Client Platform releases documentation and participate of the Regulatory and Compliance Management (RCM) committee to thoroughly understand any change or new functionality that could impact compliance with CMS, state regulations and/or benefit design and have awareness of the impact on future incidents.
• Collaborate in the development of new ideas and requirements to resolve system issues and improve current systems.
• Participate in projects and new clients’ implementations to gather understanding on new system functionalities and requirements to have a better understanding of issues and collaborate with the issue resolution.
• Understand and document system logic and/or processes.
• Create and conduct training on system logic and/or processes within the Operational Performance Team. (TAMD)
• Collaborate and support users during issue solving activities, new business requirements gathering, and day-to-day system operation.
• Collaborate interdepartmentally with key areas within the organization.
• Be a go-to person for your team members when seeking expertise in logic.
• Support your leaders with the oversight of your team’s compliance with the Issue Management process.
• Support the company-wide issue management process.
• Document identified issues in accordance with Company’s policies and procedures and agreed upon SLAs.
• Ensure all incidents are addressed, and resolutions, workarounds, and/or mitigations are in place within the expected SLAs.
• Monitor Issue Management activities and be the point of contact for clients and operational areas.
• Follow-up on escalation processes to ensure Operational areas are meeting expected SLAs.
• Ensure that Issue Management process is followed by the Operational areas and the company as a whole.
• Maintain Incident Management log, reports, metrics, and ensuring these reports are sent within agreed SLAs.
• Design, develop, and manage/lead plans to resolve complex incidents, including coordinating meetings with Operational Areas and external parties. Keep track and be able to provide reporting of all related activities until its resolution.
• Support and monitor the log of recurring incidents for escalation purposes.
• Contribute in the design and definition of new metrics relevant to the Issue Management
• Work with Analytics and SMEs to determine impact analysis of issues identified.
• Analyze data provided in impact analysis.
• Work with Analytics and Rx Customer Service to coordinate and conduct outreach to pharmacies as part of mitigation plans.
• Communicate issues to clients in accordance with policies, procedures, and SLAs.
• Follow through with corrective actions or improvement projects, including evidence of testing and updating policies and procedures.
• Assist in implementation process to ensure testing takes into consideration past issues (Assist is another word for contribute or collaborate.)
• Track metrics for issues encountered and report accordingly to the Quality Committee or as otherwise directed.
• Interface with the Client on issues identified as part of the Issue Management Strategy
• Support Quality Improvement Projects or Company projects as needed.
• Collaborate on the company-wide issue management process and committee.
• Participate and complete other tasks as assigned and other projects or duties as needed.

 What you’re made of

The bold requirements…   

• Bachelor’s or Master’s Degree in Science, Management, Business (In lieu of a degree, equivalent relevant work experience may be considered.)
• 3+ years of experience within a related role in a healthcare or non-retail pharmacy setting.
• Experience with project planning, management, and reporting
• Experience with pharmacy benefit management operations or Medicare Part D.
• Experience with quality, audit, controls, and business process improvements.
• Experience with data management and analysis.
• 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)
• This position requires availability to work in a specified time zone or working schedule, accommodating the business needs of our clients and team members.
• This position may require availability for on-call hours, including evenings, weekends, and holidays, to promptly address emergent issues or provide necessary support as dictated by operational demands (if applicable).

Nice to have…

• Certifications in areas such as Project Management, Agile or related.

Physical requirements…

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

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.

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

All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of gender, race/ethnicity, gender identity, sexual orientation, protected veteran status, disability, or other protected group status.

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