Formulary Analyst

Abarca Health LLC.; San Juan, Northern (PR, KY); Hybrid; USD 65,000 - 90,000; Full time

Job summary

Abarca Health LLC in San Juan, PR, is seeking a Formulary Analyst to configure and implement formularies across Medicare, Commercial, and Employer clients, handling complex setups and process changes. You will execute testing, conduct design and QA reviews, participate in UAT, analyze adjudication issues, and collaborate across teams to ensure compliant, accurate formulary design and training.

This role supports on-site work in Puerto Rico with a flexible hybrid model and opportunities to

Qualifications

• Associate or bachelor’s degree in a related field.
• Pharmacy Technician accreditation and active license.
• Experience in PBM industry and group benefits.
• Excellent written and verbal communication skills.

Responsibilities

• Configure standard and complex formulary setups for Medicare, Commercial and Employer clients.
• Perform unit testing to confirm configuration changes work as defined by client docs.
• Conduct design reviews and QA to ensure accuracy of formulary management processes.
• Participate in UAT testing and resolve adjudication/processing issues.
• Provide triage support to verify pharmacy claims within SLAs/SLOs and collaborate with teams to implement changes.
• Create and maintain knowledge articles on formulary topics and train others.

Skills

Communication skills

PBM industry experience

Group benefits knowledge

Technical writing

Education

Associate or Bachelor's degree in related field

Pharmacy Technician license

Job description

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 a 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 and complex 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.
• Participate as needed in UAT testing for product enhancement/updates to confirm operational/business user acceptance.
• Perform research and resolution of adjudication and processing issues including, identification of root cause, impact analysis determination and corrective action.
• 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.
• Perform consultations internally and externally on formulary design.
• Assist in the review of pharmacy formulary audits from the PBMs and assist in any remediation.
• Act as a client support resource while participating as a member of the formulary team. Responsible for daily tracking and monitoring of assigned requests to ensure due dates are met.
• 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.
• Identify functionality and design needed to achieve client outcomes and collaborate with product and adjudication teams to plan and deliver appropriately.
• Understand and document system logics and processes, as well as create and conduct training on them.
• Guide and mentor other team members to improve overall client relations and higher quality outcomes.
• Author new or maintain knowledge articles related to formulary topics.
• Support the Knowledge Accelerator team in creating content, as needed, for training on subject matter expertise and process.
• Support with in-depth training new team members in configuration setup and standardized quality procedures.
• Evaluate and analyze processes and make recommendations for improvements.

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.)
• 3+ years of work-related experience in PBM industry and operations.
• Pharmacy Technician accreditation as well as a current and active license.
• Experience with group benefits, services, and programs.
• Experience writing so requirements, expectations, results, and conclusions are read easily.
• Experience with established PBM Technology Companies.
• Experience applying professional presence and business acumen to effectively manage clients, prospects, partners, and vendors.
• Experience with basic statistics and management reporting.
• Excellent oral and written communication skills.
• 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 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.