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.The Darwin Claims Operations team handles all claims verifications, day to day configuration set-up and maintenance as well as related special projects, issue management and research for configuration.

As a PBM Operation Manager, you’ll be responsible for working closely with our Configuration Services Managers to triage configuration tickets for Medicare, Medicaid, Commercial and Employer clients. You will also interpret client configuration requests, defining their request complexity, needs and requirements, to recommend the best operational approach and build repeatable processes. Additionally, you will work hands-on to overview operational issues, analyze and identify solutions to resolve issues in configuration setup, claims processing and other operational gaps, as well as track trends and identify process improvement opportunities to make plan configuration design setup more efficient.

The fundamentals for the job…

• Work with PBM Configuration Services & Operations Leadership to create and drive process for definitions of configuration request type.
• Review configuration ticket queue and triage open tickets to Analysts and Leads strategically and in alignment with client SLA’s and department SLO’s.
• Interpret business requests and determine scope of impact and categorize the complexity of the request to drive accurate SLA assignment.
• Support best practices and recommended approaches to trend solutions.
• Work closely with Configuration Leads and Configuration Architects to determine impact scope and solutions.
• Build, track and monitor department SLA reporting, review and compliance.
• Monitor queues and issue trends to identify opportunities for associate coaching and mentoring.
• Assess error trends and recommend solutions and/or training opportunities to PBM Configuration Services and Operations Leadership.
• Work as a liaison between the business areas within PBM Configuration Services and Operations to ensure alignment, communication and priorities are clear.
• Create a system of early identification of configuration issues.
• Proven ability to demonstrate proactiveness in identifying opportunities for process improvement, problem-solving, and anticipating potential challenges in a dynamic work environment.
• Develop process documentation, including Policies and Procedures, to document Darwin Configuration operational processes.
• 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.

What we expect of you

The bold requirements…

• Bachelor’s degree in Accounting, Finance, or related field. (In lieu of a degree, equivalent relevant work experience may be considered.)
• Experience utilizing dashboard tools, (e.g., Tableau, QVW, and Excel tools).
• 8 years of work-related experience.
• 4 years of PBM and/or configuration experience.
• Ability to apply critical thinking skills to manage responsibilities.
• Extremely detail oriented.
• Excellent oral and written communication skills.
• Proficiency in SQL query writing and execution, with the ability to retrieve, manipulate, and analyze data efficiently.
• 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 as a leader of others within the PBM or Healthcare setting.
• Learning and development and/or training experience within healthcare operations, client services, configuration, and/or call center.
• SQL

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.

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