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.
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