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 our Regulatory Analyst, you will be responsible for ensuring that business operations and procedures are compliant with all state and federal regulatory requirements and abide by State Medicaid Plans as applicable to Abarca. You will ensure that business owners receive, understand, and abide by all federal and state regulations. You will be an independent and critical thinker, and an effective communicator. It is important that you are always up to speed on all regulations applicable to Abarca operations and delegated services.

In this position you will support the Regulatory Compliance Team, in executing Abarca’s Regulatory Change Management Process, including regulatory trainings, Policies & Procedures management, and regulatory consults. You will perform a range of duties such as evaluating compliance regulations and guidance, supporting operational areas in the implementation and documentation of new requirements, and researching and responding to regulatory consults. You will also be responsible for acting as a consultative figure to our clients on regulatory topics, addressing possible changes to delegated services and regulatory questions stemming from potential audit concerns. 

The fundamentals for the job…

• Stay abreast of all regulatory requirements and legislation, industry trends, and best practices.
• Keep track of regulatory changes for Commercial, Medicare and/or Medicaid, as assigned, including State Medicaid requirements for those states in which Abarca processes claims.
• Monitor regulatory changes and assess any potential impact of these changes in Abarca’s processes.
• Work with business areas to discuss identified changes in regulation, define required actions, and ensure requirements are implemented as appropriate.
• Participate in the Regulatory Change Management (RCM) Committee meetings, presenting regulatory updates and engaging participation of subject matter experts (SME’s).
• Prepare Compliance Updates and summaries of regulatory requirements identifying required actions, for internal and external stakeholders and maintaining updated Abarca’s regulatory log.
• Work with operational areas to ensure that required actions derived from guidance are completed, including implementation of new processes, updating current processes, and advising on compliant operations, in accordance with applicable due dates.
• Lead Policies and Procedures Management process, creating or reviewing P&P’s and ensuring that P&P’s are reviewed within required frequency, and updated with federal and state regulatory requirements, current operations, and overall business operations.
• Develop a user-friendly system for maintaining the organization’s policies and procedures and ensure they are properly published to the entire organization.
• Implement regular communication methods to keep all employees informed of policy and procedure updates.
• Perform research and review guidance to provide timely responses to regulatory questions from clients and business areas.
• Support the Regulatory Compliance Audits team with regulatory requirements and documentation.
• Support in the development/update of regulatory compliance training materials. Ensure all Abarcans and delegated entities receive new hire and annual regulatory trainings. Develop ad-hoc trainings of regulatory topics as needed.
• Support HIPAA investigations, specifically review and keep track of applicable federal and state requirements, including State Medicaid requirements and Client Business Associate Agreements. Act as liaison with the Security Team when system security issues are involved.
• Maintain and report results on Compliance metrics and assigned Service Level Agreements.

What we expect of you

The bold requirements…

• Bachelor, Law Degree, or Master’s Degree in Health Services Administration, Public Health, Health Evaluation or related field (In lieu of a degree, equivalent, relevant work experience may be considered.)
• 3+ years experience in regulatory management role within healthcare or pharmacy benefit management (PBM) industry.
• Experience with Medicare.
• Strong understanding of industry processes, healthcare regulations, and PBM Operations.
• 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).
• 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 haves…

• Preferred Certification in Healthcare Compliance (CHC), and/or Certified Fraud Examiner (CFE), and/or Certified Internal Auditor (CIA).

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. 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-JD1

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 Sales and Business Development gurus are the revenue generating team within Abarca. They're entrusted with foraging and developing relationships with prospects andconsultants andhandle everything related to marketing our value proposition, demoing our capabilities, proposal management, and contracting. 

As Associate Vice President of Consultant Sales, you’ll be responsible fordeveloping pipeline directly through payors and bymanaging existing and creating new consulting firm relationships. The primary areas of focus will be to coordinate relationships with key contacts in thehealth plan andconsulting community, drive strong relationships,understanddemoand shareour solutions and capabilities, and collaborate with key groups within Abarca as needed.  As AVP of Consultant Sales, you will be measured on pipeline creation and business contracted. You’ll also exemplify the aspirational performance-oriented culture of Abarca, exudinghumbleconfidence and always seeking to improve the already great relationships we’ve created over the years, ultimately generating revenue for the company. 

The fundamentals for the job…  

• Developfull sales cycle from prospecting, RPF management, negotiating company specific contracts and pricing (including detailing language for contract execution).
• Collaborate with analytics, product, and marketing teams to create and update educational material for the consulting community.
• Create and deliver prospect andconsultant value proposition messaging highlighting Abarca’s differentiators in the PBM industry.
• Support the RFP strategyfrom the beginning to the end.
• Develop target market strategies and create a sales toolkit required to sell services in conjunction with Abarca’s SVP of Sales, through addressable market analysis and market knowledge by creating go-to market strategies.
• Ensure all targeted prospect contacts and engagement opportunities are recorded in Salesforce.
• Execute strategy for specific pipeline development that supports the assigned sales goals.
• Maintain and improve existing national and regional consultant relationships by strategically allocating resources to maximize growth and retention.
• Create and manage consultant scorecards that provide insight into win/loss and retention results on a quarterly basis.
• Collaborate with Marketing and Technology to create the Book of Business reviews on an annual basis.
• Attend and speak at events including conferences, consultantsummits, and other health plan events.
• Be exceptionally open and proactive in addressing problems as they arise, bring solutions to the leadership team, and present clear recommendations.
• Possess the self-confidence to operate in a direct environment, speaking up and providing opinions grounded in fact while remaining humble and taking direction well. 

What you’re made of 

The bold requirements…  

• Bachelor’sDegree orMaster’s Degree in Business Administration, Healthcare, or a related area (In lieu of a degree, equivalent, relevant work experience may be considered.)
• 10+ years of experience in a consulting, sales, or account management role working with benefit consultants in the healthcare or government market segment.
• Experience successfully forging productive relationships within the healthcare community.
• Experience developing and maintaining trusted relationships with key partnerships that take a long-term view of business opportunities.
• Experience proactively creating relationships and opportunities across both internal and external boundaries to develop innovative solutions to meet our prospect and consultantneeds.
• Experience utilizing Salesforce and contribute to approach for developing, updating, and maintaining relationships with the key contacts at consulting firms.
• Experience successfully interacting, presenting to, and influencing senior leadership.
• Excellent oral and written communication skills.
• Must be available to travel (25nights per year) to industry events, client meetings, headquarters and other sites as needed.
• We are proud to offer a flexible hybrid work model which will require certain on-siteworkdaysin Puerto Rico. 
• This position requires availability to work in a specified time zone or working schedule,accommodation forthe 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 providenecessarysupport as dictated by operational demands (if applicable). 

Nice to haves…  

• MBA or PharmD is a plus. 

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 andparticipatesin E-Verify.  “Abarca Health LLC does not sponsor employment visasat 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-NO1 #LI-REMOTE

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…

The Legal & Compliance department ensures our business operations and processes are compliant with all state and federal requirements. They keep Abarca updated on all regulatory and legislative developments to mitigate impact on the services we offer! They're also the team we go to for channeling services from our external legal counsel and working on matters related to tax, audits, managing codes of conduct as well as corporate, and healthcare law.

As our Senior Compliance Auditor, you will be responsible for ensuring successful completion of assigned audit engagements set forth in the company’s Audit Plan with the delegated entities. You will manage and carry out operational audit activities as assigned. You will also be responsible for any external audits including Abarca’s delegated entities. In this position you are also responsible for applying audit & monitoring techniques to examine documentation, interview employees, and conduct analysis of data to identify deficiencies and best practices in controls and compliance with the Center for Medicare and Medicaid Services (“CMS”) requirements as well as any other relevant agency and organizational policies and procedures. As our Senior Compliance Auditor, you need to be knowledgeable about the regulatory requirements that apply to the areas subject to auditing and monitoring activities as conducted under the compliance program.

The fundamentals for the job…

• Identifying and managing potential risks associated with delegation of services, such as data breaches, compliance violations, or operational disruptions.
• Manage the execution and documentation of all auditing and monitoring activities, according to the established annual work plan.
• Ensure processes are followed in accordance with policies and procedures and regulatory guidance.
• Perform analysis and trending compliance audits. Continuously evaluate specific audit/monitoring activities and determine if more formal or in-depth interventions are required.
• Prepare clear and concise reports with the evaluations of risk, root cause, and scope of impact of the internal audit findings.
• Performance Monitoring- tracking and evaluating the performance of delegated entities through regular reporting, audits, and reviews to ensure accountability and transparency.
• Develop and implement audit tools based on regulatory protocols and guidance.
• Work with areas to identify root cause and ensure any findings are corrected promptly and documented properly.
• Perform follow-up monitoring as required to assess improvement on findings and ensure effectiveness of corrective actions resulting from previous audit/monitoring activities as well as issue management process.
• Act as liaison between Clients and the Company for the coordination of external audits, facilitating a responsive and responsible audit process, including corrective actions, if applicable.
• Keep up to date with regulatory requirements and best practices.
• Create or review any policies and procedures or training, as needed.
• Establish and manage communication and escalation methods.
• Serve as liaison between Compliance and Abarca business units relating to all audits performed by client or regulatory agencies.
• Coordinate with areas for reporting requirements or audit universe submissions, including gathering reports, performing quality assurance validations and final submission to clients.
• Other Compliance, audit, or reporting requirements activities as needed.

What we expect of you

The bold requirements…

• Bachelor’s or Master’s degree in Health Services Administration, Public Health, Health Evaluation, Health Economics, Statistics, Science, or a related mathematics field. (In lieu of a degree, equivalent relevant work experience may be considered)
• 6+ years of experience in Medicare Part D Compliance or Audits.
• Experience in PBM Operations.
• Experience executing audits to evaluate compliance with CMS regulations and Part D requirements, including but not limited to coverage determinations, appeals, credentialing, PDE submissions, and formulary management.
• Demonstrated ability to work in collaboration with internal and external stakeholders.
• Strong problem-solving and negotiation skills within a regulatory context.
• 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 haves…

• Certified in Healthcare Compliance (CHC), and/or Certified Fraud Examiner (CFE), and/or Certified Internal Auditor (CIA).

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. 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-JM1

LI-HYBRID #LI-JM1

Whatyou’lldo  

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… 

Asan AssociateFormularyAnalyst,youwillberesponsibleforconfiguring and implementing formularies across Medicare, Commercial, and Employer clients, including complex setups and process changes. 

The fundamentals for the job… 

• Execute standard formulary setups for new Medicare, Commercial and Employer client implementations, and process changes for existing clients.
• Perform unit testing to confirm configuration set-up or changes are processing as expected as defined in the client documentation.
• Conduct design review of peers on the proposed build design and configuration peer review.
• Perform Quality Control and Quality Assurance functions to assess information accuracy in all Formulary Management processes.
• Support the research and resolution of adjudication and processing issues including, identification of root cause, impact analysis determination and corrective action.
• Apply appropriate senseof urgency support to other areas to verify and analyze claims processing cases, eligibility, and other operational situations and issues referred for validation within SLAs/SLOs.
• Collaborate and coordinate with other business units to execute configuration as required.
• Responsible for daily tracking and monitoring of assigned requests to ensure due dates are met.
• Basic understanding of external regulator guidelines such as Medicare, Medicaid, and state requirements, to make timely adjustments to operations ensuring our processes follow compliance, rules, and regulations.  
• Provide feedback on processes and make recommendations for improvements.
• Support analysts in creating new knowledge articles related to formulary topics. 

 What we expect of you 

The bold requirements… 

• Associate orBachelor’sdegree in a related field(In lieu of a degree, equivalent, relevant work experience may be considered.).
• 1+ years ofexperience in a healthcare non-retail pharmacy setting within asimilar or related role. 
• Pharmacy Technician accreditationas well as a current and activelicense. 
• Experience with areas of clinical expertise. 
• Experience applying customer service and presentation skillswithin clinical operations. 
• Excellent oral and written communication skills. Bilingual fluency in Spanish and English isrequired. 
• We are proud to offer a flexible hybrid work model which will require certain on-site work days(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 haves…  

• Experience or coursework in expanded benefitsand/orinsurance industry.  
• Experience withPBM clinical operations and Medicare Part Dregulations.  

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 andparticipatesin E-Verify.  “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’ssimply meant to give readers an idea of what the role entails. 

#LI-REMOTE #LI-JD1

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 the Director of Configuration Operations, you will oversee the pharmacy operations team, ensuring that consultative and quality-focused configuration solutions are delivered to clients promptly. Your team serves as the face of Abarca configurations, and your role is to lead them in adhering to quality processes that meet our clients' needs. This position encompasses managing all aspects of successful configuration, including the creation of components, following system design standards, and executing testing methods to guarantee quality and consistency. You will address issues within the team and across departments to achieve desired outcomes and may also involve reviewing and negotiating tactical and strategic solution options to ensure client satisfaction.  You will engage with various departments and roles within the company as well as a dynamic combination of external clients and stakeholders.  Hence your messaging, executive presence and situational awareness are critical.  Applying various influencing techniques to gain alignment will be a part of your day-to-day execution skills.

The fundamentals for the job…

• Leadership and Team Management: Oversee configuration operations teams, providing strategic direction, mentorship, and professional development to ensure high performance.
• Strategic Client Relationship Management: Establish and maintain strong, long-term relationships with key clients at an executive level, serving as the primary escalation point for complex issues.
• Strategic Planning and Data Analysis: Conduct high-level data analysis to identify trends and opportunities, developing and presenting strategic recommendations to clients.
• Client Communication and Reporting: Lead the development of communication strategies to convey configuration options and recommendations, ensuring clear and impactful client reports and presentations.
• Collaboration and Cross-Functional Coordination: Collaborate with internal departments to ensure seamless configuration and service delivery, enhancing interdepartmental communication and collaboration.
• Gap Analysis and Solution Design: Conduct advanced gap analysis to evaluate complex client requirements, providing high-level insights and recommendations for solution design.
• Training and Mentorship: Lead training programs for clients and internal teams on advanced configuration tools and processes, mentoring Senior Configuration Architects and other team members.
• Post-Implementation Support: Oversee post-implementation activities, resolving advanced configuration issues and ensuring client satisfaction.
• Continuous Improvement and Innovation: Propose and lead enhancements to improve configuration efficiency and effectiveness, driving initiatives for continuous process improvement and innovation.
• User Acceptance Testing (UAT): Lead and participate in UAT testing for advanced product enhancements, ensuring thorough testing and validation of configurations to meet client requirements. Ensure thorough testing and validation of configurations to meet client requirements.
• Monitoring overall performance and managing the development of the Configuration Operations teams, including setting, reviewing, and measuring quality standards, documentation standards, processes, and procedures.
• Conduct performance reviews, quarterly/semiannual check-ins, and staff meetings to guide performance management and employee development efforts and direct them toward departmental goals, including quality and process improvement efforts.

What we expect of you  

The bold requirements…    

• Bachelor’s Degree or Master’s Degree in Engineering, Business or Health Administration. (In lieu of a degree, equivalent relevant work experience may be considered.)
• 10+ years of experience within a role in pharmacy benefit management and external regulator guidelines (such as Medicare, Medicaid, and state requirements).
• Experience within a leadership role overseeing teams and developing them.
• Ability to prioritize and handle multiple projects at once without missing deadlines.
• Excellent oral and written communication skills.
• Excellent analytical and problem-solving 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…

• Experience working with Azure and SQL.
• Pharmacy Technician accreditation.
• Project Management Certification/Experiences

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.  “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-NO1 #LI-REMOTE

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 Data Exchange team handles all incoming and outgoing data with scrutiny and security in mind. As Manager of Data Exchange Support, you will lead our efforts in improving and maintaining a robust 24/7 support model for our B2B data exchange services, ensuring high availability, reliability, and exceptional customer experience.

The fundamentals for the job…

• Establish and maintain KPIs for data exchange operations, focusing on client satisfaction, response time, and resolution efficiency.
• Enhance observability and monitoring through automation, implementing tools and techniques to proactively identify and address issues.
• Establish proper managerial routines to address issues in a timely manner, ensuring swift resolution and minimizing impact on operations.
• Develop and implement team Service Level Objectives (SLOs), creating comprehensive dashboards to track performance and guide decision-making.
• Lead and institutionalize a robust Root Cause Analysis process for all major incidents and recurring issues. Translate RCA findings into actionable improvement plans and preventive measures.
• Collaborate with business data management teams, engineering, and clients to ensure seamless data exchange and support processes.
• Manage and prioritize multiple projects and support tickets, ensuring adherence to service level agreements (SLAs).
• Manage, coach, and develop a team of data support specialists.
• Lead the transition to support 24/7 operations, collaborating with the Network Operations Center (NOC) to optimize processes.
• Partner with engineering teams on optimizing data pipelines to ensure data quality, consistency, and accessibility across the organization.
• Partner with engineering teams on initiatives to address technical debt and improve testing processes.
• Create and maintain comprehensive documentation for relevant support procedures.
• Oversee disaster recovery and business continuity planning for data systems.

What we expect of you

The bold requirements…

• Bachelor's Degree or Master's Degree in Computer Engineering, Computer Science, or related field. (In lieu of a degree, equivalent relevant experience may be considered.)
• 8+ years of experience in data engineering operational role. 
• 2+ years of experience in a managerial role.
• Excellent leadership, problem-solving, and decision-making skills.
• Outstanding collaboration, communication, and interpersonal skills.
• Proven ability to establish and maintain operational routines and drive continuous improvement.
• Experience in managing and reducing incidents and recurrent issues in data operations.
• Familiarity with cloud platforms (AWS, GCP, or Azure) for data engineering.
• Strong customer service orientation with a track record of building relationships with internal and external stakeholders.
• Proficiency in implementing and managing observability and monitoring solutions for complex data systems.
• Experience in establishing and tracking Service Level Objectives (SLOs) and creating performance dashboards.
• 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 haves…

• Certifications in process excellence methodologies (e.g., Six Sigma, Lean) or ITIL.
• Familiarity with HIPAA regulations.
• Experience in ETL design and implementation.
• Advanced knowledge of automation tools and techniques for data engineering and support processes.
• Experience with healthcare utilization reporting, claims, membership, provider data, and standard Healthcare metrics.

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.  “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-BM1

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…

The Data Architect is responsible for designing, implementing, and overseeing an enterprise-wide data architecture that aligns with the organization's data strategy and goals. This role involves collaborating with internal teams, stakeholders, and leadership to manage data solutions across multiple platforms and ensure data quality, integrity, and security. The Data Architect will lead efforts to implement data-driven solutions, streamline data management processes, and support the organization in evolving its data architecture, including future initiatives like data mesh, data fabric, and graph databases.

The fundamentals for the job…

• Coordinate with internal teams to support clients, data users, and key stakeholders to develop and achieve long-term objectives for data architecture.
• Design short-term solutions to achieve project goals and create a data roadmap for management.
• Determine procedures for identifying and collecting required data, validating processes, and recommending improvements to corporate data.
• Oversee and monitor frameworks that manage data across the organization, ensuring data quality and integrity.
• Support the Product and Data Management Team in applying methodologies that adhere to required data standards.
• Administer mapping of all data sources and data movement, analyzing them to ensure appropriate quality. 
• Collaborate with project supervisors and business leaders to manage enterprise data projects.
• Manage data-related problems such as system configuration and integration on multiple platforms.
• Provide training to staff on data management, improving operational efficiency.
• Develop key metrics for data quality tests, ensuring data architecture integrity.
• Prepare and maintain documentation for data architecture, ensuring knowledge on large data structures.
• Analyze information flow and recommend appropriate technologies to support business processes.

What we expect of you 

The bold requirements…

• Bachelor’s Degree or Master’s Degree in Engineering, Business or a related area (In lieu of a degree, equivalent, relevant work experience may be considered.)
• 8+ years of experience implementing large-scale data solutions, particularly in healthcare and pharmacy data domains.
• Deep knowledge and experience with data architecture, management strategies, including data profiling, cleansing, and conversion.
• Strong leadership and stakeholder engagement skills with excellent oral communication, presentation, and problem-solving abilities.
• Experience in communicating complex data architecture designs effectively to both technical and non-technical audiences.
• Proven track record of designing, implementing, and managing data architectures in large environments interfacing multiple subsystems.
• Experience collaborating with architects and leads, serving as the data SME across architectural contexts.
• Expertise in providing technical advice on data management, governance, and enterprise data integration strategies.
• Demonstrated experience in data migration, transformation, and deployment in collaboration with DBAs, development, security, and operations teams.
• Experience developing SLAs and data governance standards to ensure data integrity, retention, and compliance.
• Familiarity with emerging data strategies and technologies like data mesh, data fabric, and graph databases.
• Proven ability to manage data across technologies such as Microsoft SQL Server, Azure SQL, CosmosDB, PostgreSQL, Redis, Solr, and Azure Service Bus for streaming.
• Drive the design and implementation of a data-driven strategy across all components of Darwin, fostering the concept of data products per domain.
• Excellent oral and written communication skills.
• 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).

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.  “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.

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 client 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. Within this division, our Quality Assurance & Oversight team leads the charge in quality oversight, root cause analysis, findings and corrective actions regarding adjudications and pharmacy claims.

As our Quality Assurance Analyst, you’ll be the go-to person for answers and prompt solutions, guaranteeing high quality continues to distinguish our technological platforms. You will be responsible for performing tests and monitoring activities as part of projects, new client implementations and/or new functional requirements implementations, ensuring the quality of the systems and processes that support the company’s operation. You will be tasked with understanding business requirements and technical specifications, identifying, and defining testing scenarios, and creating, executing, and documenting test cases/scripts conducted to existing functionalities, as well as to new features and/or fixes deployed to our systems. You will work with other key functional areas to ensure the quality and integrity of business requirements testing and monitoring efforts. You will come up with best operational approaches to testing, serve as a second-tier triage when issues arise, and will save the day analyzing and identifying solutions to resolve testing issues.

The fundamentals for the job…

• Optimize and perform testing and monitoring activities to ensure the quality of the systems and processes supporting the company’s operation.
• Be an SME on all lines of business (Medicare, Medicaid, commercial, etc) and stay current with regulatory guidelines, ensuring testing complies with rules and regulations.
• Develop, document, and execute test plans, and test cases and/or scripts based on functional requirements.
• Analyze, document, and report on test results to business stakeholders, company leads or external clients.
• Document and track issues identified during testing activities to ensure defect resolution and testing completion.
• Identify missing requirements based on test-cases development and testing experience.
• Guide other QA Analysts as they learn what you already know and share the knowledge.
• Lead development of new ideas and requirements to resolve testing and system’s issues, and improve current systems based on testing results by collaborating within the department and outside the department.
• Design testing documentation templates and testing scope as required by new client implementations.
• Conduct peer reviews of testing results and documentation to ensure the quality of the work being provided to the client on an as need basis.
• Create the first draft of policies and procedures related to testing and quality activities and assist in the ongoing maintenance of said policies.
• Participate on projects and new client implementations to gather understanding on new system functionalities and requirements that will require testing and/or monitoring.
• Create and conduct training on system logics and/or processes and be the champion that the team goes to when they have questions.
• Guide team members during issue-solving activities, new business requirements gathering, and day-to-day system operation.
• Work cross-functionally to properly carry out changes and evaluate impact of new system requirements.
• Participate in Prioritization and/or Request Management Meetings to coordinate testing when new functionalities are implemented.
• Lead the way in tracking and reporting of key quality metrics to monitor testing efforts and results.
• Gather proper and accurate documentation and data during internal and external audits related to the Company’s PBM processes.
• Perform additional tasks or special projects as assigned.

What we expect of you

The bold requirements…

• Associate’s Degree or Bachelor’s Degree in Business, Engineering, Healthcare, or related field. (In lieu of a degree, equivalent relevant work experience may be considered.)
• 3+ years of experience or equivalent in a health plan and pharmacy benefit management setting.
• Experience with testing methodologies, troubleshooting, root cause analysis, quality assurance practices and tools.
• Experience in analyzing large data sets through dashboard tools (e.g., Tableau, QVW and Excel tools).
• Excellent oral and written communication skills in Spanish and English.
• We are proud to offer a flexible hybrid work model which will require certain on-site work days (Puerto Rico Location Only). 
• This position requires availability for on-call hours, including evenings, weekends, and holidays, to promptly address emergent issues or provide necessary support as dictated by operational demands.
• This position requires availability to work in a specified time zone, accommodating the business needs of our clients and team members based in the determined time zone.

Nice to haves…

• Experience with software development life cycle and quality assurance.
• Experience with pharmacy benefit management operational standards and processes, Medicare Part D, and 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. 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-TA1

Whatyou’lldo  

Inafew 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… 

The Legal & Compliance department ensures our business operations and processes are compliant with all state and federal requirements. They keep Abarca updated on all regulatory and legislative developments to mitigate the impact on the services we offer! Within this team, the Pharmacy Integrity group handles FWA and related regulations to ensure we're maintaining standards and compliance in all pharmacy related processes, claims and transactions. 

As our Pharmacy Integrity Specialist, you will be responsible for performing audits of pharmacies within the Company’s Provider network, as detailed in the Company’s Network Agreements. Audits are a fundamental part of maintaining a first-class and comprehensive network and must be completed with great attention to detail to prevent, identify and control potential cases of Fraud, Waste and Abuse (FWA), as defined by CMS. Additionally, as a Pharmacy Audits Specialist you must maintain excellent relations with members of the Provider Network and internal partners. 

The fundamentals for the job… 

• Complete in-person andlong-distanceaudits of pharmacies within the Company’s Provider Network, paying special attention to conforming to all Company, Client, and CMS policies and proceduresincludingprescriptions, documentation,and credentialing.  
• Collectvirtual andphysical evidence of claimsas well ascarry out pharmacy onsite audits. 
• Investigate paid claims toidentify errors, track patternsforpossible casesof FWA.  
• Prepare quarterly reports on audit processes and timelines, detailing recent findings,determiningoverpaymentsas well as submit findings adequately.  
• Analyze FWA referrals from clients, other departments,members,and hotline calls.   
• Reviewand promptly respond to requests for information from law enforcement agencies and plan sponsors (clients).  
• Analyze audit findings todeterminevalidity of any identified discrepancieswhile bearingthe full responsibilityof identified issues during audits.  
• Write the final audit discrepancies notification letter and audit report for pharmacies.  

What we expect of you

The bold requirements…  

• Pharmacy Technician Associate Degree (In lieu of a degree, equivalent relevant work experience may be considered.) 
• 3+ years of experience in a related role. 
• Experienceworking withfraud, waste and abuse regulationsand industry trends. 
• Experience in handlingfull analysis, from issue identification up to providing reports. 
• Excellent oral and written communication skills.Bilingual fluency in English and Spanish is required.
• We are proud to offer a flexible hybrid work model which will require certain on-site workdays (Puerto Rico Location Only) 

Nice to haves…  

• Specialty Pharmacy experience is preferred. 
• Experience within the Healthcare, Pharmacy Benefit Management, and Insurance industriesis a plus.  
• Certified Fraud Examiner.  
• Experience related toCMSandMedicare Part Dis preferred.  

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’ssimply meant to give readers an idea of what the role entails. 

Abarca Health LLC is an equal employment opportunity employer andparticipatesin E-Verify. “Applicant must be a United States’ citizen. Abarca Health LLC does not sponsor employment visasat 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.

#LI-NO1 #LI-REMOTE

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…

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 claims verifications, daily configuration set-up and maintenance, and related special projects, issue management and research for benefit configuration.

As a Darwin Claims Analyst, you will be responsible for implementing new and updating existing benefit plan setups for Medicare, Medicaid, Commercial and Employer clients. Also, you will review client configuration requests, identify, and define their needs and requirements, determine the best operational approach, and perform setup in the Pharmacy Benefit Manager system. The position also requires that you perform client configuration setup testing on all plan benefit design changes into a production scenario to ensure proper and accurate configuration for claims processing and adjudication. Additionally, you will provide first 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…

• Pharmacy Benefit Manager System Configuration setup and maintenance for pharmacy benefits, networks and pricing for Medicare, Medicaid, Commercial and Employer groups.
• Perform testing to confirm configuration set-up or changes are processing as expected as defined in the client documentation.
• Develop in-depth understanding of Darwin (proprietary adjudication platform) system logics to ensure benefit designs are configured to meet client request.
• Provide timely first-tier triage support to verify and analyze pharmacy claims processing case research referred for validation.
• Support pharmacy claims adjudication research, analysis, identification of root cause, impact analysis determination and corrective action.
• Responsible for daily tracking and monitoring of assigned requests to ensure due dates are met.
• Utilize critical thinking and organizational skills to ensure all work is performed with the highest level of quality, accuracy and delivered timely.

 What we expect of you

The bold requirements…

• Associate or bachelor’s degree. (In lieu of a degree, equivalent relevant work experience may be considered.)
• 3+ years of work-related experience.
• Experience working with SQL and Excel tools.
• Ability to establish good interpersonal skills.
• 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 in a healthcare non-retail pharmacy setting.
• Experience related to Pharmacy Benefit Manager Operations, Member Services, Pharmacy Networks, Fulfillment, Call Center, and Medicare.

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.

 #LI-NS1 #LI-REMOTE

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…

The Cloud Infrastructure Engineering Team manages and maintains all cloud-related systems, network, and infrastructure at Abarca Health. Our team ensures peak performance, availability, stability and security of our cloud-based systems and platform. We leverage the latest Azure technologies to continually improve and modernize our cloud operating environment. We partner with product and software development teams to drive business outcomes.

Azure Cloud Engineers -FinOps are responsible for the maintenance of secure and highly available cloud computing environments. This position is designed for someone who is passionate about leveraging cloud technologies to optimize financial operations within Azure environments. You will be instrumental in driving cost-efficiency and maximizing cloud investment returns.

The fundamentals for the job…

• Implement and manage Azure cloud services focusing on cost optimization and financial governance.
• Collaborate with IT and finance departments to develop and enforce cloud spend policies and best practices.
• Analyze and report on cloud expenditures, providing insights and recommendations for cost savings and operational efficiencies.
• Use Azure Cost Management tools to monitor, allocate, and optimize expenditures across multiple departments and projects.
• Develop automated solutions for budget tracking, alerting, and reporting to enhance visibility and control over cloud costs.
• Design and implement tagging strategies to ensure accurate cost allocation and chargebacks.
• Lead cloud cost reduction initiatives, including reserved instances, sizing, and scaling adjustments.
• Stay updated with Azure’s pricing and service catalog to advise on cost-effective cloud architectures and services.
• Train and mentor team members on Azure cost management practices and tools.
• Collaborate with architecture and engineering teams to ensure cost-efficiency is embedded in all cloud projects.

What we expect of you

The bold requirements… 

• Bachelor’s degree in Computer Science, Information Technology, Finance, or a related field.
• 3+ years of experience in cloud engineering with a strong emphasis on Microsoft Azure environments.
• Deep understanding of Azure services, pricing models, and billing dashboard.
• Proven experience with Azure Cost Management, Budgets, and other financial management tools.
• Strong analytical skills and the ability to interpret financial data to make business recommendations.
• Experience with scripting languages (PowerShell, Python, etc.) for automation of cloud services.
• Excellent communication and collaboration skills to work effectively across teams.

Nice to haves…

• Certifications in Azure, such as Azure Cost Management and Billing preferred.
• Financial experience, cost accounting/billing experience.

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.

#LI-REMOTE #LI-MH1

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 IT Service Operations team is critical for success at Abarca Health. You will handle day to day systems operations and monitoring of data processing to server updates, review stability and collaborate to ensure the stability of networks and datacenters.

As the Monitoring and Tools Analyst, you will be part of our IT Service Operations team, and will be responsible for building, maintaining, and supporting the monitoring tools used to detect, mitigate, and resolve application and infrastructure issues. This includes setting-up, maintaining, and continuously improving Abarca’s various monitoring, visualizations, alerting and notification tools, enabling other teams to respond to incidents, as well as providing recommendations for areas of opportunity.

The fundamentals for the job…

• Install, configure, and maintain the tools used by the organization for monitoring, alerting, notifying, and diagnosing issues.
• Configure and continuously improve the instrumentation of our infrastructure and applications.
• Collaborate with the software engineering teams to better instrument and monitor application features before they are released.
• Monitor vendor information to ensure tools are updated, secured, and optimally implemented as they change.
• Work with the IT Service Operations teams and organizational leaders to produce meaningful visualizations of the monitoring metrics.
• Provide regular updates and reports associated with SLA adherence.
• Create, update, and maintain the documentation of current and new tools.

What we expect of you

The bold requirements…

• Bachelor’s degree or Master’s Degree in Computer Engineering, Computer Science, Information Technology, or related field (In lieu of a degree, equivalent relevant experience may be considered.)
• 3+ years of experience within an IT Operations Support team maintaining the surveillance and monitoring tools or related roles.
• Experience with network infrastructure, network hardware, server operating systems (Windows and Linux), server hardware, server storage, relational databases (MS SQL Server, MySQL, or others) as well as Eventlogs and Syslogs.
• Experience with SNMP and WMI for obtaining metrics and with concepts associated with Web Applications.
• Experience visualizing data.
• Experience with of monitoring tools such as Dynatrace, App Dynamics, Datadog, Splunk, New Relic, Solarwinds, PagerDuty, Evolvenor SCOM.
• Availability to work rotating or irregular shifts, including weekends and certain holidays, per business or operational needs.
• 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).

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.

#LI-MH1 #LI-REMOTE

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 to price eligibility to government services and beyond. Our beneficiaries' every concern is satisfied whether it be for a prior authorization, script concern or case management follow up. They're not just an operations team as they also set strategy for new clinical programs based on accurate data. Collaboration is also key as they work with teams like Software Development to design quality processes that meet client requirements, test our systems, and ensure benefits and claims are configured and processed correctly!

As a Medicare Part D Letter Analyst, you will be tasked with conducting investigations and resolving complex issues via strong analytical and communication skills. We’ll rely on you to execute and monitor letter processes for Medicare Part D business including EOBs, Transition, Formulary Negative Change, OIG Exclusion, Provider Preclusion Letters, and more. Grasping new concepts and acquiring platform knowledge through independent study, as well as interaction with other team members, will be essential here. The ability to discuss technical logic, awareness of when to be detailed, and assurance evoked through extensive understanding of our solutions and technology is also a key part of this role!

 The fundamentals for the job…

• Monitor Part D letters and dashboards; identify and initiate error resolution as necessary.
• Analyze pharmacy claims, formulary, provider data, and pricing changes and determine how those affect downstream letters.
• Track, trend, and monitor issues as they arise.
• Understand and reference guidance when analyzing and resolving issues.
• Identify and proactively suggest process improvements.
• Document and explain observations to technical and non-technical audiences.
• Provide guidance and solid understanding of Medicare Part D processes the impact letters.
• Assist in new client implementations and existing client re-implementations to ensure accurate letter logic and content.
• Locate, read, understand, and apply CMS guidance to processes as necessary.
• Understand and execute the quality assurance checks on Medicare Part D processes and communications.
• Review inbound and outbound data files, utilize reports to ensure Medicare Part D process accuracy in various business functions.
• Stay up to date on CMS guidance related to Medicare Part D products.
• Provide client support and/or compliance/audit activities and collaborate in special projects and activities.

What we expect of you

The bold requirements…

• Bachelor’s degree in a related field. (In lieu of a degree, equivalent, relevant work experience may be considered.)
• 3+ years of combined or relevant work-related experience.
• Experience with Medicare Part D processes within a pharmacy benefit manager or health plan.
• Ability to analyze data, reports, and findings to discern patterns and discrepancies.
• Problem solving and analytical skills that are applicable to role processes and procedures.
• Ability to thrive in a high-growth, fast-paced, complex, shifting, and uncertain business environment.
• Highly organized and self-motivated to run and complete important investigations simultaneously.
• 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 pharmacy paid claim calculations and accumulators is strongly preferred.

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.

#LI-NO1 #LI-REMOTE