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 Pharmacy Benefit Manager Operations and Services team provides high quality services to clients and members by running services from clinical programs, pricing, eligibility, configurations, and beneficiary services to government services and beyond. The Darwin Claims Operations team handles all claims verifications, day to day configuration set-up and maintenance as well as related special projects, issue management and research for configuration.
As a Supervisor, Formulary Services you will be responsible in supporting team members as a subject matter expert for questions and training, organizing, and distributing work for individuals as well as configure pharmacy benefit set-up in our DARWIN (proprietary adjudication platform) system. You will ensure consistency with company strategy, plans, commitments, and goals, while also coaching and being a mentor to our team.
The fundamentals for the job…
- Process configuration plan setup and maintenance for new and existing Medicare, Medicaid, Commercial and/or Employer clients
- Organize and distribute work for individuals within the team with support from the Manager.
- Responsible for development of team, performance review, growth conversation, and calibration processes
- Supports Lead role in training new team members in configuration setup and standardized quality procedures.
- Support the Knowledge Accelerator team in creating content, as needed, for training on subject matter expertise and process.
- Provide timely second-tier triage support to analysts when needed for service requests, case verification, incident management related tickets submitted by the client and internal stakeholders.
- Leads special projects and initiatives in area.
- Guide and mentor other team members to improve overall client relations and higher quality outcomes.
- Collaborate with peers as technical subject matter expert and go to person supporting requests as needed.
What we expect of you
The bold requirements…
- Bachelor’s or Master’s degree in Engineering, Computer, Healthcare, Business, or related field. (In lieu of a degree, equivalent, relevant work experience may be considered.)
- Pharmacy Technician accreditation as well as a current and active license.
- 6+ years of experience in Pharmacy Claims Operations within a pharmacy benefit manager, including 2+ years of experience leading teams.
- Excellent analytical and problem-solving skills.
- 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.
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