Associate Claim Services Analyst

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 Associate Claims Services Analyst is responsible for the completion of all reprocessing tasks and claims adjustments in a timely manner. These involve claims reprocessing and adjustments for all lines of business including commercial, Medicaid, and Medicare. Part of the job is to collaborate with the issue management team to ensure tasks related to Abarca’s clients are completed satisfactorily. You’ll also be responsible for other analytical processes, supporting external audits as needed, and performing other tasks related to Abarca’s clients’ financial performance.

The fundamentals for the job…

• Conduct claim reprocessing and adjustments, including initial approvals, related to claim adjudication errors, configuration changes and operational requests including any restacking for Medicare clients. Ensure a proper and timely resolution.

• Conduct detailed quality reviews of reprocessing results to ensure accuracy of all work.

• Collaborate with other internal teams to analyze claim reprocessing accuracy, reduce errors and prompt resolution of requests.

• Monitor, track, and communicate client ready updates for all assigned tickets and tasks.

• Ensure all client requests are managed according to established SLOs/ SLAs and communicate to the Reprocessing Manager any risks in a timely manner

• Participate, as requested, in internal calls and client meetings to provide updates and explanations regarding assigned reprocessing tickets and tasks with support from Lead and/or Manager

• Run SQL queries, request reports from Analytics, and use data to make decisions.

What we expect of you

The bold requirements…

• Associate’s Degree in Business, Audit, Insurance, Healthcare, or related field. (In lieu of a degree, equivalent relevant work experience may be considered.)

• 1+ years of experience in analytical, claims processing, benefit configuration, quality assurance or auditing role in healthcare.

• Experience solving complex problems and paying attention to detail.

• Intermediate experience with reporting, analysis and data management in Excel.

• Experience with the prescription claim life-cycle.

• Ability to quickly spot trends and discrepancies, with financial acumen and solid analytical thinking skills.

• Excellent oral and written communication Spanish & English skills.

• We are proud to offer a flexible hybrid work model which will require certain on-site workdays (Puerto Rico Location Only).

• This position requires availability to work in a specific 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 dictated by operational demands (if applicable).

Nice to haves…

• Prior experience in pharmacy benefit management.

• Experience related to Medicare and Medicaid.

Physical requirements…

• Must be able to access and navigate each department at the organization’s facilities.

• Sedentary work that primarily involves sitting/standing.

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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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