What you’ll do
In a few words…
Ah, yes, there are many benefits of being a Darwin Configuration Analyst I, and you’ll get to know them all intimately… In this role you’ll be responsible for implementing new and updating existing benefit plan setups for Medicare, Medicaid, Commercial and Employer clients. As DCA I, you will review client configuration requests, identify and define their needs and requirements, determine best operational approach and perform setup in the PBM system. The position also requires that you perform client configuration setup testing as well as QA functions such as moving all plan benefit design implementations and/or changes into a Production scenario to ensure proper and accurate configuration for claims processing and adjudication. As DCA I, you will overview operational issues, analyze and identify solutions to resolve issues in configuration setup, claims processing and other operational gaps, as well as identify process improvement opportunities to make plan configuration design setup more efficient.
The fundamentals for the job…
- To warm up, you will process plan configuration setup for new Medicare, Medicaid, Commercial and Employer client implementations, and also process configuration changes for existing clients.
- Monitor and analyze key data and procedures for proper claims processing and adjudication system functionality (i.e. eligibility management, configuration setup) for all clients.
- Perform Quality Control and Quality Assurance functions to assess information accuracy in all configuration processes, such as, but not limited to, benefits, formularly, and network.
- Provide timely support to other areas to verify and analyze claims processing cases, eligibility and other operational situations and/or issues referred for validation. (“Timely” is a favorite term for around here, since anything else is the same as “late”.)
- Support urgent adjudication and processing issues including doing research, analysis, identification of root cause, impact analysis determination and corrective action.
- Work cross-functionally to properly carry out changes, evaluate impact of new system requirements and assist in the design and execution of test scripts.
- Help gather proper and accurate documentation and data during internal and external audits related to the Company’s PBM processes.
- Develop process documentation, including Policies and Procedures, to document Darwin Configuration operational processes.
- You should understand and document system logics and/or processes.
- Stay current with external regulator guidelines (such as Medicare, Medicaid, and state requirements) in order to make timely (see?) adjustments to operations ensuring our processes are in compliance with rules and regulations.
- Perform client or prospect client facing to present demos around the PBM configuration platform.
- Evaluate and analyze Darwin Configuration process requirements to make recommendations for improvements.
- All in all, the role requires putting your best foot forward for the benefit of all our processes. In a timely manner, for sure.
- Perform other duties and special projects as assigned.
What you’re made of
The bold requirements…
- Associate or Bachelor’s Degree (preferred), and 2+ years in a healthcare non-retail pharmacy setting (preferred). (In lieu of a degree, equivalent relevant work experience may be considered.)
- Computer proficiency (of course this is a must), knowledge of Microsoft Office products (you can at least stand your ground while using them), programing knowledge (this is a plus) and Internet experience (who doesn’t know how to use the Internet expertly these days? Well, whoever they are, you definitely don’t fall within their ranks).
- We’ll be very swayed (meaning it’s a big plus) if you already have a strong understanding of PBM Operations, Member Services, Pharmacy Networks, Fulfillment, Call Center, and Medicare.
- You’re great critical thinking (as befits an analyst of any stripe). You know what it means to be a “share the credit / take responsibility” worker. You ride change like an expert surfer rides waves. And let’s not forget your top-rated presentation skills!
- You are willing and able to utilize dashboard tools, e.g. Tableau, QVW, and Excel tools.
- Must be able to communicate effectively (read, write, speak, daydream, argue, flatter, retort wittily etc.) in English and Spanish.
That something extra we´d love to see…
- Analytical: You value the power of context & enjoy examining the past. You get the present by analyzing (sometimes over-analyzing) events leading up to it. This methodology is super helpful, but can provoke analysis-fatigue in those within earshot. Good thing you’re aware of this.
- Adapter: A responsive climate-switcher who is highly productive in a fast-paced environment. Practically shape-shifts to adjust to different situations.
- Innovator: You constantly engender unexpected ideas; your factory of pure genius just doesn’t run out. Fascinated with possibilities you are, in turn, fascinating yourself. You plainly see or figure out connections between seemingly disparate phenomena, à la A beautiful mind. It is a child’s game to you.
- Fixer / Problem solver: You like to provide comprehensive solutions, keeping in mind both internal and external needs. You keep with the mantra of always being part of the solution (not the precipitate). Those who precipitate, you’ve learned, repent at leisure
- Responsible: You own what you say and what you do. Your word is your bond; you don’t let people down when you commit to something. You live by established values like honesty and loyalty but sometimes you can be a bit judgmental
The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is absolutely not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.
Abarca Health LLC is an equal employment opportunity employer and participated in E-Verify. 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.