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 Operational Performance team is #All-In on centralizing data to dive through and study as they work on improving operations at Abarca. The Operational Solutions team works hand in hand with other departments to listen to their needs, analyze potential opportunities, mitigate issues, co-create preventable measures, and monitor all improvements from start to close. That’s why performance is part of their name as they help drive both scalability and efficiency across the board!
As anAssociate 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 to the development and implementation of issue management activities such as defining policies & procedures, workflows, and training.
- 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.
- 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.
- 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.
- 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.
- 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, including but not limited to evidence of testing.
- 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…
- Associate’s Degree or Bachelor’s Degree in Science, Management, Business or a related area. (In lieu of a degree, equivalent relevant work experience may be considered.)
- 1+ 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)
- 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.