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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 Darwin Claims Administration team provides high quality services to clients and beneficiaries and meets that standard by configuring timely and accurate updates related to plan benefit, pricing, and network changes and beyond. The Darwin Claims Administration team handles all pharmacy claims verifications, daily configuration set-up and maintenance, and related special projects, issue management and research for benefit configuration.
As the Manager for Pharmacy Claims Operations, you will be responsible for overseeing and supervising the Claims Administration team. You will be responsible for the accurate set up of new clients in the pharmacy benefit manager processing system and updating existing benefit plan setups for Medicare, Medicaid, Commercial and Employer clients. This role will require time on leadership activities including assigning work via ticketing system, training, coaching, and triaging issues. The manager will also support process improvement initiatives and ensure adherence to department standard desktop procedures. The position also requires that you oversee and ensure proper client configuration setup testing on all plan benefit design changes into a production scenario to ensure accurate configuration for claims processing and adjudication. Additionally, you will provide second level triage for operational issues, analyze, and identify solutions to resolve issues in configuration setup, claims processing and other operational gaps.
The fundamentals for the job...
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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
Full Time
$103k-123k (estimate)
04/23/2024
05/08/2024
abarcahealth.com
SAN JUAN, PR
50 - 100
2005
JASON BORSCHOW
$5M - $10M
Ancillary Healthcare
Abarca is igniting a revolution in healthcare. We started by redefining pharmacy benefits, but this is just the beginning. We built our company on the belief that with smarter technology and a straightforward approach to business, we can provide a better experience and greater value for payers and consumers. For fifteen years, we have questioned the industry status quo and changed what it means to be a PBM. So call us a PBM for discussion purposes, but we are unlike any other company out there. And today, we manage more than $5.3 billion in drug spend for 4.1 million lives with unheard of clie...nt satisfaction and retention. Join the revolution!
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