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…

Our Quality Assurance & Oversight team is key to implementing new clients, testing claims within their respective lines of business and ensuring all claims are paying out correctly. The Quality Assurance team ensures test cases and scripts are developed on the requirements clients has specified and while designing quality review processes with other departments. Along with them, the Product Quality team leverages these skills and functions by focusing on all Abarca related products and software services by collaborating with Product Teams.

As our Product Quality Analyst you will partner with the Product Team to ensure that business requirements originating from them are developed accurately and configured into our claims adjudication platform, while the Quality Assurance Analysts and Software Testers support the development and testing. You will execute all business functional testing activities to ensure the quality of each client’s pharmacy benefit design and that all new logic integrates with other plans’ programs. As such, understanding those requirements, designing, and defining testing scenarios, executing them and documenting them will be an important aspect of your role. Due to the hands-on level you will take on in this role, the team will support your developing knowledge of both technical and operational sides of the business as you make recommendations on corrective actions and process improvement for testing and monitoring.

The fundamentals for the job…

• Optimize testing and monitoring activities to ensure the quality of the systems and processes supporting the company’s operation.
• Develop into a subject matter expert (SME) on certain lines of business and adjudication logic while stay current with regulatory guidelines.
• Develop, document, and execute test plans, and test cases and scripts based on business functional requirements (independent of Software Test Engineer test plan).
• Analyze, document, and report on test results to business stakeholders and SDLC teams.
• Document and track issues identified during testing activities to ensure defect resolution and testing completion.
• Perform functional testing of the specific adjudication changes being requested, their integration with the specific client rule being tested and related impact to other products. (e.g. member portal, platform visualization).
• Review executed test results with Scrum team, business users, and requestors to ensure acceptance and approval of the results.
• Log all documentation of test plan execution and results in a centralized area available for all SDLC teams.
• Contribute to the business requirement gathering process by identifying missing requirements based on test-cases development and testing experience.
• Collaborate in the development of new ideas and requirements to resolve testing and system’s issues, and improve current systems based on testing results. Collaborate with the Software Test Engineering team to develop and improve testing strategies, techniques, procedures, and tools.
• Participate in product grooming and refinement meetings to gather understanding of new system functionalities and requirements that will require testing and monitoring.
• Team up to support users during issue-solving activities, and day-to-day system operation.

What we expect of you

The bold requirements…

• Bachelor’s degree or Master’s Degree in Business, Engineering, Healthcare, or related field. (In lieu of a degree, equivalent relevant work experience may be considered.)
• 3 years experience with program testing (claims processing testing), quality assurance practices and tools.
• Experience in pharmacy benefit manager (PBM) setting.
• Experience as a detail-oriented problem-solver, able to quickly spot trends and discrepancies.
• Experience analyzing large data sets while able to use dashboard tools (e.g. Tableau, QVW and Excel tools).
• Experience leveraging strong analytical and critical thinking by being, innovative, accountable and a team worker with a desire to be challenged.
• Experience with Microsoft Office products (e.g. Excel, Power BI).
• 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 with software development life cycle (SDLC), quality assurance (QA) and SQL Management Studios.
• Experience operational standards and processes for healthcare, pharmacy, pharmacy benefit management, Medicare Part D, and Centers for Medicare and Medicaid Services (CMS) regulations.

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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