Lead, Operations Support

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…

Our Operational Performance team is #All-In on centralizing data to dive through and study as they work on improving operations at Abarca. Operations Support team works hand in hand with other departments to listen to their needs, analyze potential opportunities, mitigate, and resolve issues, co-create preventable measures, and monitor all improvements from start to close. That's why performance is part of their name as we help drive both scalability and efficiency across the board!

As a Lead, Operations Support you’ll support the direction to the Operations Support Team (that manage the Issue Management Process), regarding prioritization of tasks and tickets, analysis and documentation, timelines and deliverables, new employee training, and deadline adherence. As our compass you will be responsible to support the timely performance and completion of all activities of Issue Management Process of the organization; specifically, quality of documentation, and compliance with due dates and contractual SLAs, overseeing and monitoring the Issue Management process. You’ll also work with other key functional areas to ensure the Issue Management Process is followed. This position shall also make recommendations for corrective and preventive measures, and process improvement.

The fundamentals for the job…

• Responsible to support and oversees the company’s Issue Management process which includes:
  • Lead the company-wide issue management process and committee.
  • Responsible for the documentation of identified issues in accordance with the Company’s policies and procedures and agreed upon SLAs.
  • Ensure all incidents are addressed, and resolution, workaround and/or mitigations are in place within the expected SLAs.
  • Monitor Operations Support activities and be the secondary contact point for clients and operational areas.
  • Responsible for following escalation processes to ensure Operational areas are meeting expected SLAs.
  • Ensure that Issue Management processes are followed by the Operational areas.
  • Oversee tasks delegations based on individual strengths, skill sets, and experience levels.
  • Support and conduct meetings with clients. Prepare and share meeting minutes.
  • Work with Analytics and SMEs to determine impact analysis of the issues identified. Further, work with outreach and reprocessing teams as applicable to remediate claims or issues.
  • Ensure that issues are communicated to clients in accordance with policies, procedures, and SLAs.
  • Collaborate with the definition/documentation of root cause, impact criteria, resolution, preventive measures, and corrective actions.
  • Follow through with corrective actions or improvement projects, including evidence of testing and updating policies and procedures.
  • Support the interfacing with the Client on issues identified as part of the Operation Support Strategy.
  • Monitor Issue Management Performance contractual agreement of clients.
  • Contribute to the definition and the implementation of strategic initiatives to improve the issue management processes, tools, and reporting capabilities.
  • Support the development and maintenance of policies and procedures related to Operation Support activities and Issue Management process.
• Create and maintain comprehensive Issue Management process documentation.
• Understand, document, and update Issue Management processes and procedures to ensure they are aligned with company policies and contractual agreements.
• Coordinate training for the Operations Support team and other functional/technical areas within Abarca.
• Monitor performance indicator.
• Reviewing best practices.
• Collaborate with the Operations Solutions Manager to design, develop, and manage/lead plans to resolve complex incidents, including coordinating meetings with Operational Areas and external parties. Keep track and be able to provide reporting of all related activities until their resolution.
• Develop comprehensive action plans to be shared with clients and other teams within Abarca, when needed.
• Interpret Darwin RxEngine and Client Platform releases documentation and participate of the Regulatory and Compliance Management (RCM) committee to thoroughly understand any changes or new functionality that could impact compliance with CMS, state regulations, and/or benefit design, and define and implement necessary processes.
• Lead and support users during issue solving activities, new business requirements gathering, and day-to-day system operation.
• Collaborate interdepartmentally with key areas within the organization.
• Support Quality Improvement Projects or Company projects as needed (mostly related to issues identified as part of the Issue Management process).

What we expect of you

The bold requirements…

• Bachelor’s Degree in Engineering, Mathematics, Business Administration, (In lieu of a degree, equivalent relevant work experience may be considered.)
• 6+ years of experience in a healthcare non-retail pharmacy setting.
• Experience and solid expertise in project planning, management, and reporting.
• Experience with PBM Operations and Medicare Part D.
• Knowledge in pharmacy claim adjudication.
• Understanding of Pharmacy Benefit Configuration.
• Experience with quality, audit, controls, and business process improvements.
• Advance knowledge in Excel.
• Experience with SQL queries.
• Availability to work rotating or irregular shifts, including working over the weekend and certain holidays, per business, clients or operational needs.
• 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)

Nice to have…

• Master’s Degree in Engineering, Mathematics, Management.
• PMP and/or Agile certification.
• Bilingual fluency in Spanish and English

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.