AVP, PBM Configuration Services

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 AVP, PBM Configuration Services you’ll be dedicated to supporting how we configure the platform for our clients. The Darwin Claims Operations team is responsible for initial set-up, quality, and maintenance of the benefit, pharmacy network, pricing, reprocessing and formulary design and system logic configurations as defined and documented by our clients. The AVP is responsible for leading and strategically managing all aspects of claims processing within the organization to ensure excellence at the point of service. Part of the job is to continuously evaluate processes to improve where possible, develop team members and their objectives, and establish metrics to measure the productivity and quality of your team.

The fundamentals for the job…

• Lead and manage teams of pharmacy benefit management (PBM) professionals within the configuration services department to deliver high quality.
• Collaborate with senior leadership to develop and execute long-term strategies for the growth and success of the configuration services department within Abarca.
• Serve as a subject matter expert on pharmacy benefit configuration processes and practices, representing the department in client meetings, industry conferences, and internal discussions.
• Formulates strategic initiatives and collaborates on the development of relevant OKRs (Objectives, Key Results), tracking the advancement of established objectives.
• Establishes and oversees the monitoring of key performance indicators (KPIs) to assess the efficacy and productivity of configuration services, instituting corrective measures as necessary.
• Stay abreast of industry developments, regulatory changes, and emerging technologies related to pharmacy benefit management, integrating relevant advancements into configuration practices.
• Provide leadership and mentorship to team members, fostering a culture of accountability, collaboration, and continuous improvement.
• Implements staffing strategies to cultivate a team of subject matter experts in the Darwin adjudication platform, Abarca’s ongoing expansion.
• Defines definitive product priorities for both external clients and internal stakeholders within the realms of configuration and adjudication.
• Serve as an integral part of the organization’s leadership team to help strategically plan for growth and develop ways to increase the optimal operational efficiencies and quality of claims processing at point of service.
• Collaborate with cross-functional teams to plan and execute projects and to deliver the highest quality of service for all clients and partners.
• Maintain a standard of continuous process improvement, including setting up the necessary control mechanisms for issue escalation.
• Ensure the configuration team remains current to any system changes or new functionalities that could impact compliance with CMS and state regulations and/or benefit design.
• Conduct performance reviews, quarterly/semi-annual check-ins, and staff meetings to guide performance management and employee development efforts and direct them toward departmental goals, including quality and process improvement efforts.
• Establish and cultivate teamwork, communication, and accountability.

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 experience can be considered).
• 12+ years of experience in a leadership role in the Pharmacy Benefit Manager industry.
• Experience with operations and external regulator guidelines (such as Medicare, Medicaid, and state requirements).
• Experience leading teams within the pharmacy claims management and configuration arenas.
• Experience with dashboard tools, such as Power BI and Excel tools.
• Experience with handling multiple projects at once in collaboration with internal and external stakeholders.
• Excellent verbal 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.