Eligibility Data Analyst

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…

Providing high quality services to clients and beneficiaries is at the core of what we do every day! The Pharmacy Benefits Management Client Success team is the very heart of Abarca and meets that standard by leading services from client implementations including data exchange, benefit configuration, project management, ongoing support of client data and beyond. After a client is implemented, the Client Data Operations Team manages the day to day inbound and outbound client data exchange with a primary focus on eligibility and accumulator data via file or API mechanisms.

As a Member Data Analyst, you will be responsible for the day-to-day oversight of the inbound and outbound files and data that Abarca exchanges with our clients. This includes responsibilities such as review of file loads, error analysis, reconciliation of data, with a primary focus on eligibility and accumulator data.  You will support monitoring our client’s service level agreements to ensure file loads or extracts are completed on time.  We need your analytical skills and keen eye to provide timely analysis in support of client data requests as well as identify improvements to our client data exchange processes.

The fundamentals for the job…

• Assess file load rejects and threshold limit conditions, identify root cause and take action to remediate
• Act on file alert conditions and remediate (e.g. missing file)
• Monitor and track file processing, ensure adherence to client schedules and SLAs
• Perform quality assurance review of data loads (e.g. review load reports, sampling of data) and take corrective action if data issues are identified
• Manage the Accumulator and Eligibility review and reconciliation processes to ensure Abarca and client systems match.
• Complete analysis and provide findings for assigned client data requests within SLA response time
• Ensure adherence of existing controls around data exchange.
• Use analytical tools, such as SQL to conduct data analysis, respond to client requests and identify client-specific solutions.
• Identify improvements to existing client data exchange processes and communicate those solutions to technical and non-technical audiences
• Collaborate with internal teams on client implementations and actively participate with internal workgroups to support activities such as testing client file loads and extracts, review of load reports, documenting results and share with internal team, etc.

What we expect of you 

The bold requirements…

• Bachelor 's Degree or Master’s Degree in a related area. (In lieu of a degree, equivalent relevant work experience may be considered.)
• 3+ years of experience with PBM or health plan data exchange (EDI/ETL) functions.
• Experience developing SQL queries.
• Experience related to relational database architecture and data standards.
• 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, accommodating the business needs of our clients and team members based in the in the determined time zone.
• This position requires availability for on-call hours, including evenings, weekends, and holidays, to promptly address emergent issues or provide necessary support as dictated by operational demands.

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.

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