Product Quality Analyst

Abarca Health LLC.; Puerto Rico; Hybrid; USD 85,000 - 110,000; Full time

Benefits offered by this job

Hybrid work model (Puerto Rico on-site

On-site days in Puerto Rico

Job summary

Abarca Health LLC is seeking a Product Quality Analyst to partner with the Product Team, ensuring business requirements are accurately translated into our claims adjudication platform. You will guide QA activities, collaborate with testers, and ensure high quality client pharmacy benefit designs.

The role requires a strong QA mindset, data-driven analysis, and the ability to work in a flexible hybrid model with on-site days in Puerto Rico.

Qualifications

• Bachelor’s or Master’s degree in business, engineering, healthcare, or related field (or equivalent work experience).
• 3+ years experience in a health plan or pharmacy benefit management setting, claims processing testing and/or QA.
• Experience with testing methodologies, project management, troubleshooting, root-cause analysis, quality assurance practices and tools.
• Experience analyzing large data sets with dashboards (SQL, Tableau, QVW and Excel).

Responsibilities

• Lead development of test plans and cases from business requirements.
• Document, track, and report issues to ensure timely resolution.
• Ensure test coverage for adjudication changes and integrated components (e.g., member portal, platform visualization).
• Review results with Scrum team and stakeholders for acceptance.
• Collaborate with Software Test Engineering to improve testing strategies and tools.
• Mentor team members and participate in grooming sessions for new functionality.

Skills

SME on adjudication logic

Test planning & test cases

Documentation & reporting

Defect tracking & remediation

Test coverage & risk assessment

Stakeholder communication

Requirements gathering

Mentoring & leadership

Cross-functional collaboration

On-call coordination

Education

Bachelor’s or Master’s degree in business/engineering/healthcare

Tools

SQL Server Management Studio

Tableau

QlikView / QVW

Excel

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 our Product Quality Analyst you will partner with the Product Team to ensure that business requirements originating from them are developed accurately and configured into our claims adjudication platform, while the Quality Assurance Analysts and Software Testers support the development and testing. You will execute all business functional testing activities to ensure the quality of each client’s pharmacy benefit design and that all new logic integrates with other plans’ programs.

What we expect of you

The bold requirements…

• Serve as a subject matter expert (SME) on certain lines of business and adjudication logic while staying current with regulatory guidelines.
• Develop, document, and execute test plans, and test cases and/or scripts based on business requirements (independent of Software Test Engineer test plan).
• Complete analysis, documentation, and reporting to both internal and external stakeholders.
• Document and track issues identified during testing activities to ensure defect resolution and testing completion; including collaboration and alignment with others to ensure accurate and timely resolution.
• Ensure appropriate test coverage and execute on said coverage on requested adjudication changes being requested, any impacted areas (such as benefits rules), as well as other integrated components (e.g., member portal, platform visualization).
• Review executed test results with Scrum team, business users, and requestors to ensure acceptance and approval of the results.
• Adhere to all current and future company processes and specific Quality Assurance or SDLC documentation or validation processes.
• Engage in business requirement gathering process; providing feedback to ensure that the requirements are well-defined and testable.
• Lead development of innovative ideas that resolve or accelerate the resolution of testing and system issues
• Actively collaborate with the Software Test Engineering team to develop and improve testing strategies, techniques, procedures, and tools
• Actively participate in product grooming and refinement meetings to gather understanding of new system functionalities and requirements to position appropriate test coverage.
• Partner to support users during issue-solving activities, new business requirements gathering, and day-to-day system operation.
• Lead and develop others by actively sharing your direction, expectations, insights, and experiences with team members through daily interactions and mentoring.
• Operate in a cross-functional mindset, that ensures ownership, collaboration, and appropriate actions are taken place to achieve the final outcomes.
• Perform additional tasks or special projects as assigned.

Bachelor’s degree or Master’s Degree in Business, Engineering, Healthcare, or related field. (In lieu of a degree, equivalent relevant work experience may be considered.)

3+ years experience in a health plan or pharmacy benefit management setting, claims processing testing and/or quality assurance role.

Experience with testing methodologies, project management, troubleshooting, root cause analysis, quality assurance practices and tools.

Experience as a detail-oriented problem-solver, able to quickly spot trends and discrepancies.

Experience analyzing large data sets while able to use dashboard tools (e.g. SQL, Tableau, QVW and Excel tools).

Experience leveraging strong analytical and critical thinking by being, innovative, accountable and a team worker with a desire to be challenged.

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 with software development life cycle (SDLC), quality assurance (QA) and SQL Management Studios.
• Experience operational standards and processes for healthcare, pharmacy, pharmacy benefit management, Medicare Part D, and Centers for Medicare and Medicaid Services (CMS) 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.