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 an Associate Formulary Analyst, you will be responsible for configuring 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 sense of 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 or Bachelor’s degree in a related field (In lieu of a degree, equivalent, relevant work experience may be considered.).
• 1+ years of experience in a healthcare non-retail pharmacy setting within a similar or related role. 
• Pharmacy Technician accreditation as well as a current and active license. 
• Experience with areas of clinical expertise. 
• Experience applying customer service and presentation skills within clinical operations. 
• 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 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 benefits and/or insurance industry.  
• Experience with PBM clinical operations and Medicare Part D 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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