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. Our GPS, (Government Programs & Services) teams handle direct contact, data transfers, issue management, auditing, and much more for any state or federal agencies as well as government led programs. No one else in this division can talk the talk and walk the walk on Medicare and Medicaid services like they can!

As our Client Benefit Manager, you’ll be our service lead regarding Darwin Claims Services. In this role you’ll identify and respond proactively to any situation pertaining to the client’s benefit set up in our platform. Your enthusiastic approach to driving solutions for benefit and putting our clients at the core of everything is of utmost importance. We’ll need you to maintain and guarantee the best Darwin Claims Services experience for them, as well as ensuring a positive relationship between client and organization.

The fundamentals for the job…

  • Manage assigned clients benefit requirements document from implementation to its continued maintenance of business.
  • Provides oversight of case research and change requests from clients to ensure the best possible consultative experience.
  • Engage in client requirements clarification sessions before (such as requirements sessions) and after the build of a client (such as requirement updates and E2E testing).
  • Manage client benefit operational calls, key client meetings and requests by capturing significant discussion topics and action items as well as sharing input and solutions to address client needs, considering Abarca’s priorities.
  • Maintain understanding of Darwin Platform logic and functionality as well as client business requirements and benefit rules.
  • Collaborates closely with product, service leaders and SMEs providing client requirements for new and innovative solutions.
  • Maintain and track CRM deliverables, metrics and SLAs via dashboards and reports for clients or internal teams.
  • Develop understanding of the Abarca requirements to change request to enhancement process.
  • Continuously educate key internal and external stakeholders and redirect when needed to ensure benefit requirements processes are being followed.
  • Generate and analyze client Darwin Claims Services related needs to make recommendations internally and to clients as well as identify proactively any issues with output content.
  • Present client demos around the Darwin Claims Services and configuration screens.
  • Collaborate with cross-functional teams to anticipate clients’ needs and to provide clients with the best possible service.
  • Support in the execution of department activities and tasks for areas including, but not limited to, configuration, peer reviews, user acceptance testing, case research, incident management, reprocessing accuracy, as well as internal and external audits.

What we expect of you

The bold requirements…

  • Bachelor’s Degree or Master’s Degree in Business Administration, Healthcare, or a related area (In lieu of a degree, equivalent relevant work experience may be considered.)
  • 6+ years’ experience in a healthcare and/or a non-retail pharmacy setting within related roles.
  • Experience in pharmacy claims processing platforms including building client set-ups from scratch.
  • Experience with the following lines of business: pharmacy benefit management operations, member services, pharmacy networks, fulfillment, and call center.
  • Experience with project coordination within related areas.
  • Experience in collaboration with internal and external stakeholders including clients and vendors.
  • Experience in utilizing reporting and dashboard tools (e.g. Tableau, QVW and Excel tools).
  • Excellent oral and written communication skills. Bilingual fluency in Spanish and English 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…

  • Experience with programming languages such as SQL or object-oriented programming (OOP).

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

 

 

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