Healthcare Benefits Configuration Specialist

Abarca Health LLC.; San Juan (PR); Hybrid; USD 60,000 - 90,000; Full time

Job summary

Abarca Health LLC is seeking a Configuration Analyst to support Medicare, Medicaid, Commercial and Employer client plan configurations and changes. You will perform triage, analyze issues in configuration setup, claims processing, and operational gaps, and ensure timely resolution.

You will conduct unit testing, QC/QA, root-cause analysis, and collaborate across configuration and product teams. The role requires a degree and 3+ years of experience, SQL and Excel proficiency, and willingness to

Qualifications

• Associate or bachelor’s degree; or equivalent relevant work experience.
• 3+ years of work-related experience benefit plan configuration and/or implementations.
• Experience working with SQL and Excel tools.
• Excellent oral and written communication skills.

Responsibilities

• Provide primary support for plan configuration setups for new Medicare, Medicaid, Commercial and Employer client implementations, as well as configuration changes for existing clients.
• 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 root cause analysis, impact assessment, and corrective action.
• Provide first-tier triage support within SLAs/SLOs to verify and analyze pharmacy claims processing cases.
• Collaborate with configuration teams and other business units to execute configuration as required.
• Responsible for daily tracking and monitoring of assigned requests to ensure due dates are met.
• Support review, impact analysis, root cause assessment and preventive measures for issue management related workload.
• Develop and maintain in-depth understanding of Darwin system logics to ensure configurations meet client requirements.
• Stay current with Medicare, Medicaid, and state requirements to ensure compliant operations.
• Provide consultation and peer review for configuration practices and design.
• Identify functionality needed to achieve client outcomes and collaborate with product teams to plan and deliver.
• Support in documenting client plan standards and process documentation.

Skills

Interpersonal skills

Communication skills

Education

Associate or Bachelor’s degree

Tools

SQL

Excel

Job description

Abarca Health LLC is seeking a Configuration Analyst to support Medicare, Medicaid, Commercial and Employer client plan configurations and changes. You will perform triage, analyze issues in configuration setup, claims processing, and operational gaps, and ensure timely resolution.

You will conduct unit testing, QC/QA, root-cause analysis, and collaborate across configuration and product teams. The role requires a degree and 3+ years of experience, SQL and Excel proficiency, and willingness to