Abarca Health

Content Writer

• Lead and coordinate large, complex projects and serve as a key resource for complex or critical issues pertaining to bid completion.
• Act as liaison to internal stakeholders with regard to bid opportunity, product gaps, or process roadblocks.
• Write and edit all delegated proposals from start to finish including submission to consultants.
• Maintain and continually enhance knowledge of company and process to create compelling content and responses that accurately represent capabilities.
• Engage and collaborate with key Subject Matter Experts (SME’s) to produce and improve Abarca’s proposal content to maximize the chances of delivering winning proposals.
• Edit and revise proposals according to feedback.
• Demonstrates expertise in functional area(s) or topics in order to inform the development of responses.
• Work with internal SMEs to develop new proposal content and develop appropriate language based on products and services.
• Review products, services, and business ideas to package the content in a manner that persuades and influences prospects.
• Attend and lead meetings as needed to support successful execution of the proposal package.
• Help maintain the response repository and close out proposals in the system.
• Maintain and update any documentation and exhibits as necessary or required for the proposal.
• Follow company and department policies to maintain consistency in proposal writing and meet regulatory requirements.
• Support the proposal team leadership in providing peer-to-peer reviews of work, mentoring, coaching and providing work direction to other Writers as applicable.
• Other duties as assigned.

Senior Proposal Writer

QA Engineer

• Monitor overall performance and manage the development, coordination, and administration of the Quality Assurance team, including setting, reviewing and measuring quality standards, documentation standards, processes and procedures, performance reviews, quarterly/semiannual 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.
• Develop, track and report key quality metrics to monitor and report on testing and quality efforts and results to business stakeholders and company leads.
• Develop, supervise, and perform quality assurance of benefit set-up, network, pricing, and formulary configurations.
• Lead the preparation and implementation of quality assurance activities such as testing, policies, procedures, workflows, and training.
• Contribute to the business requirement gathering process by identifying missing requirements based on test cases development and testing experience.
• Assist in gathering proper and accurate documentation and data during internal and external audits related to the Company’s PBM processes.
• Stay up to date on external regulator guidelines (such as Medicare, Medicaid, and state requirements) to assess that adjustments made to operational processes are in compliance with rules and regulations.

Manager, Quality Assurance - Pharmacy, PBM

Analyst

• Primary support for on plan configuration setup for new Medicare, Medicaid, Commercial and Employer client implementations
• Perform unit testing to confirm configuration set-up or changes are processing as expected as defined in the client documentation
• Perform Quality Control and Quality Assurance functions to assess information accuracy in all configuration processes
• Perform research and resolution of adjudication and processing issues including, identification of root cause, impact analysis determination and corrective action
• Resolution & Ownership of project-based work as assigned
• Provide first-tier triage support within SLAs/SLOs to verify and analyze pharmacy claims processing case research referred for validation
• Collaborate and coordinate both within the configuration teams and with other business units to execute configuration as required
• Responsible for daily tracking and monitoring of assigned requests to ensure due dates are met
• Support the review, impact analysis, root cause assessment and preventive measures for issue management related workload
• Continuously develop and maintain an in-depth understanding of Darwin (proprietary adjudication platform) system logics to ensure benefit designs are configured to meet client requirements with accuracy
• Stay current with 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 consultation and peer review for configuration practices and design
• Identify functionality needed to achieve client outcomes and collaborate with product and adjudication teams to plan and deliver appropriately
• Support the Sr. Analyst in documenting client plan standards
• Support in development of process documentation, including Policies and Procedures, to document Darwin Configuration operational processes
• Evaluate and analyze configuration processes and make recommendations for improvements

Configuration Analyst, Pharmacy-PBM

Customer Support

• Manage all incoming calls, emails, faxes and web-generated requests from pharmacies, beneficiaries, and prescribers.
• Provide service-level standards set by CMS or by client; 80% of calls should fall within service level, less than 5% abandon rate and speed to answer should be less than 30 seconds.
• Rejection support, including overrides.
• Provide Coverage Determination status to clients including exceptions and appeals.
• Administrative PAs- Document PA request inquiries, issues, status, and resolution in accordance with federal and department and company policies and guidelines.
• Answer questions and recommend corrective services to address customer complaints, payment status, manual reversal requests, benefit and eligibility support, provider portal support and response to price appeals.
• Report identified issues to the appropriate department, for investigation and correction, following the established procedure.

Bilingual Rx Customer Service Specialist, Seasonal

Manager

• Discuss and update medical histories, conditions, treatments, and lifestyles with beneficiaries participating in the Medication Therapy Management (MTM) and Disease Management (DM) programs.
• Answer beneficiaries’ questions regarding medication therapies and bioequivalent alternatives and explain anything else they need help with.
• Educate beneficiaries about the importance of properly following medication indications.
• Ensure the Medication Therapy Management (MTM) and Disease Management (DM) programs make a difference and add value to their life and health.
• Work with the Health Educator to ensure Medication Therapy Management (MTM) and Disease Management (DM) participants are receiving all the necessary and relevant information.
• Promote medication safety and compliance.
• Ensure compliance with Centers for Medicare & Medicaid Service (CMS).
• Work with cross functional teams to plan and execute clinical projects to deliver the highest quality of service for all clients and partners.
• Stay on the know of advances in drug therapies and management of chronic conditions.

Associate Case Manager

• Manage all incoming calls, emails, faxes and web-generated requests from pharmacies, beneficiaries, and prescribers
• Provide service-level standards set by CMS or by client; 80% of calls should fall within service level, less than 5% abandon rate and speed to answer should be less than 30 seconds
• Rejection support, including overrides
• Provide Coverage Determination status to clients including exceptions and appeals
• Administrative PAs- Document PA request inquiries, issues, status, and resolution in accordance with federal and department and company policies and guidelines
• Answer questions and recommend corrective services to address customer complaints, payment status, manual reversal requests, benefit and eligibility support, provider portal support and response to price appeals
• Report identified issues to the appropriate department, for investigation and correction, following the established procedure

Pharmacy Technician, Customer Service Specialist – Seasonal Temp

General Counsel

• Monitoring and tracking of state and federal legislative and regulatory measures impacting Abarca,
• Review, analyze and assess changes in state and federal laws and regulations, determining any risks or impact to Abarca, and coordinating with business areas to capture and document operational/system impacts and proposed solutions.
• Oversee the cross-functional implementation of legal and regulatory requirements, ensuring understanding of these requirements across business units and Abarca.
• Provide counsel on proposed legislation and regulations to impacted business units and clients.
• Assess regulatory and legal risks of any corporate initiatives and products.
• Draft responses to inquiries and consults presented by the business or clients regarding legal and regulatory requirements.
• Collaborate with our Government & Industry Partnerships team on advocacy strategies.
• Attend regulatory meetings (bi-weekly or as necessary) and coordinate with internal stakeholders on regulatory and legislative issues as they arise.
• Coordinate with clients’ internal legal counsel as needed for regulatory matters.
• Be up to date on applicable regulatory and legal requirements and be an educational source of knowledge and legal wisdom whenever needed.

Corporate Counsel, Regulatory

Associate Rx Customer Service Specialist

Call Center Representative

Pharmacy Call Center Specialist – Temp

Operations

• Manage and maintain Windows and Linux virtual machines and services within Microsoft Azure environments.
• Perform routine system administration tasks such as patching, updates, backups, and configuration management.
• Monitor system performance and availability using Azure-native tools including Azure Monitor and Log Analytics.
• Assist in the provisioning and configuration of Azure resources such as Virtual Machines (VMs), Storage Accounts, Key Vaults, and App Services.
• Automate operational and infrastructure tasks using PowerShell, Azure CLI, or other scripting frameworks.
• Support role-based access control (RBAC), identity governance, and permissions management across cloud environments.
• Collaborate with DevOps, Cloud Security, and Cloud Engineering teams to maintain reliable and secure operations.
• Maintain system documentation, standard operating procedures (SOPs), and configuration management records.
• Participate in incident response efforts and contribute to on-call rotation schedules as needed.

Cloud Operations Administrator

Account Manager

• Manage operational calls, agenda development, key client meetings and requests by capturing significant discussion topics and action items as well as sharing input and solutions to address client needs company priorities and team guarantees.
• Follow up pending topics and reach out to other business areas to provide resolutions for timely completion.
• Maintain a central log of all issues, questions, discussions, and responses.
• Be the first-tier support for Darwin Users (the users of our one-stop pharmacy benefit shop!); this requires good understanding of pharmacy as well as healthcare logics and functionality as well as client business requirements and benefit rules.
• Understanding and ensuring change requests from clients are submitted through CRM and confirmed to client within the agreed times.
• Partner up internally to effective track client deliverables and needs via use of our CRM.
• Develop of dashboards and reports to track client or internal agreed upon SLA’s and report it to Client Advisors.
• Prepare and/or request client reports from other functional areas within Abarca such as Pharmacy Networks, Benefits Configuration, Quality Assurance and Oversight as well as many more.

Actuary

• Lead development of cutting-edge predictive models using regression, ML, and simulation to forecast drug spend.
• Develop ongoing short, mid, and long-range forecasts of rebates, trends, revenue, and expenses for Abarca and its clients.
• Develop actuarial work products that inform business decision making.
• Develop prescriptive frameworks that translate model insights into targeted interventions (e.g., outreach sequencing, formulary design, provider strategies).
• Craft financial impact modeling for changes in risk, utilization management, and trends.
• Forecast trends using market indicators and Abarca solutions via explanatory variables, simulation, judgmental, and experience methods.
• Create models that showcase Abarca’s value proposition.
• Assist in modeling the impact of new regulations and quality measures (e.g., STARs).
• Communicate key results to executives and functional leads and serve as a senior thought leader and trusted advisor.
• Develop other financial models for critical priorities as needed and support underwriting with analytic models for pricing and guarantees.
• Stay ahead of predictive analytics and payor trends and participate in strategic leadership discussions and decisions.

Associate Director, Predictive & Actuarial Analytics

Support Engineer

• Act as the face representing Abarca to clients; identify, respond proactively, and triage client issues
• Provide support within Client Services Team managing operational calls, agenda development, key client meetings, and capturing action items
• Follow up pending topics and coordinate with other business areas to provide resolutions
• Support and identify special projects and process improvement opportunities; manage and document project tasks
• Serve as first-tier support for Darwin users, understanding platform logic, functionality, and client benefit rules
• Oversee SLAs, ensure client change requests are submitted through CRM and confirmed within agreed times
• Maintain and track CRM deliverables for assigned areas/clients; use dashboards and reports to track SLAs and report to Client Advisors
• Prepare and/or request client reports from other operational departments
• Generate and analyze reports to make recommendations and proactively identify output issues
• Conduct user-acceptance testing on system enhancements and document/communicate test results if requested

Account Support Analyst

Vice President

• Set overall vision for Abarca’s Client Success strategy across implementations, re-implementations, business solutions, client operations and client engagement
• Operationalize the vision and inculcate a consultative mindset and service-delivery orientation within the team and organization
• Maintain a strong understanding of PBM Operations, Member Services, Pharmacy Networks, Fulfillment, Call Center, and Medicare Part D to provide client solutions
• Oversee client relationships for all accounts and intervene strategically in decisions
• Collaborate closely with Analytics to provide Client Advisors and clients with timely and informative data
• Recruit, build and manage teams delivering both full-service PBM offering and a SAAS partner
• Provide visibility on departmental deliverables, projects and processes related to prioritization and delivery of client priorities
• Establish and maintain executive-level relationships with key clients
• Identify service, program and product delivery opportunities and champion delivery across leaders
• Oversee all client implementations and re-implementations including scope, deliverables, timelines and handoffs
• Ensure implementation deployments with minimal defects and timely post-implementation resolution
• Partner with other leaders (SVP PBM Operations, VP Product, CIO) and Business Development to prioritize and execute client priorities