- Contribute to the definition of tactical and strategic initiatives to improve oversight and issue management, processes, tools, and reporting capabilities.
- Participate in the preparation for CMS, client or internal audits as well as follow through on any corrective actions requiring QA.
- Contribute to the implementation and continuous development of any systems and/or tools used to support Issue Management activities.
- Interpret Darwin RxEngine and Client Platform releases documentation and participate of the Regulatory and Compliance Management (RCM) committee to thoroughly understand any change or new functionality that could impact compliance with CMS, state regulations and/or benefit design, and define and implement necessary oversight processes.
- Understand, collaborate and participate in the development of new ideas and requirements to resolve system's issues and improve current systems based on oversight results.
- Responsible for collaborating on the development and maintenance of Issue Management policies and procedures.
- Lead the company-wide issue management process and committee: Document identified issues in accordance with Company's policies and procedures and agreed upon SLAsEnsure all incidents are addressed, and resolutions, workarounds, and/or mitigations are in place within the expected SLAsMonitor Issue Management activities and be the main point of contact for clients and operational areasFollow-up on escalation processes to ensure Operational areas are meeting expected SLAsEnsure that Issue Management process is followed by the Operational areas and the company as a wholeMaintain Incident Management log, reports, metrics, and ensuring these reports are sent within agreed SLAsCoordinate, lead, and conduct meetings with US and PR clients. Prepare and share the minutesDesign, develop, and manage/lead plans to resolve complex incidents, including coordinating meeting with Operational Areas and external parties. Keep track and be able to provide reporting of all related activities until its resolutionKeep a log of recurring incidents for escalation purposes and quality oversight effortsContribute in the design and definition of new metrics relevant to the Issue Management/QA Oversight processWork with Health Analytics and SME's to determine impact analysis of issues identifiedAnalyze data provided in impact analysisWork with Analytics and Rx Customer Service to coordinate and conduct outreach to pharmacies as part of mitigation plansCommunicate issues to client in accordance with policies, procedures, and SLAsFollow through with corrective actions or improvement projects, including evidence of testing and updating policies and proceduresAssist in implementation process to ensure testing takes into consideration past issuesTrack metrics for issues encountered and report accordingly to the Quality Committee or as otherwise directedInterface with the Client on issues identified as part of the Issue Management StrategySupport Quality Improvement Projects or Company projects as needed
- Other projects or duties as needed
- Bachelor's Degree in science, Management, Business (In lieu of a degree, equivalent relevant work experience may be considered.)
- 1+ years of experience with pharmacy claims and adjudications
- Experience in PBM and/ or healthcare non-retail pharmacy setting
- Experience with data management, analysis and reporting
- Understanding of quality, audit, controls, and business process improvements
- Strong experience in Microsoft Excell
- Analytical and critical thinking, excellent writing skills, organized, innovative, accountable, work well collaboratively, negotiating, strategic thinking and planning, excellent presentation skills, strong problem-solving skills, and attention to detail
- Excellent oral and written communication skills. Bilingual fluency in English & Spanish is required
- Experience with SQL is preferred
- PMP/Agile and/or other project management certification is a plus
- Focused
- Self-sufficient
- Strategic
- Structured
- Influencer
- Must be able to access and navigate each department at the organization's facilities.
- Sedentary work that primarily involves sitting/standing.
-
Analyst, Carrier Fraud Management
hace 2 días
El Comeback San Juan, Puerto Rico De jornada completa***El Comeback is a non-profit program from ConPRmetidos that attracts and retains professional talent for Puerto Rico-based jobs. Register at to get matched with professional opportunities on the island. Candidates' searches for positions posted by El Comeback are done on behal ...
-
Analyst, Carrier Fraud Management
hace 2 días
Liberty Latin America Communications, Inc. San Juan, Puerto Rico De jornada completaWhat ́s the role? · The Analyst, Carrier Fraud Management, works within the Revenue Assurance & Fraud Management (RAFM) department to identify, quantify, report on, and resolve revenue assurance risks and fraud related cost risks related to Carrier partner contracts and services ...
-
Data Analyst, Government Programs
hace 10 horas
abarca health San Juan, Puerto RicoWhat 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... · From managing day-to-day pharmacy network operations, dev ...
-
Data Analyst
hace 10 horas
El Comeback San Juan, Puerto Rico De jornada completa***El Comeback is a non-profit program from ConPRmetidos that attracts and retains professional talent for Puerto Rico-based jobs. Register at to get matched with professional opportunities on the island. Candidates' searches for positions posted by El Comeback are done on behal ...
-
Billing Analyst Developer
hace 6 días
Liberty Latin America Communications, Inc. San Juan, Puerto Rico De jornada completaWhat ́s the role? · We are seeking a skilled Billing Analyst Developer to join our BSS team. The ideal candidate will be responsible for developing and maintaining billing systems, analyzing billing data, and implementing solutions to optimize billing processes. This role requir ...
-
Billing Analyst Developer
hace 10 horas
El Comeback San Juan, Puerto Rico De jornada completa***El Comeback is a non-profit program from ConPRmetidos that attracts and retains professional talent for Puerto Rico-based jobs. Register at to get matched with professional opportunities on the island. Candidates' searches for positions posted by El Comeback are done on behal ...
-
Project Controls Analyst
hace 3 días
Lemartec San Juan, Puerto Rico De jornada completaOverview · The Project Controls Analyst is responsible for assisting their assigned Project Manager in the planning, cost control, management direction, project completion, client satisfaction, and financial success of assigned projects. The Project Controls Analyst will be requi ...
-
QAQC Financial Analyst
hace 6 días
Tetra Tech San Juan, Puerto RicoTetra Tech is a leading provider of consulting, engineering, and technical services worldwide. Our reputation rests on the technical expertise and dedication of our employees—20,000 people working together across disciplines and time zones to provide smart, sustainable solutions ...
-
portfolio analyst
hace 1 día
First BanCorp San Juan, Puerto RicoPORTFOLIO ANALYST · PORTFOLIO MANAGEMENT ECR, SAG & REO · Our Company · At FirstBank PR , we strive to be a trusted advisor to our clients and our employees are the ones that ensure we deliver on our promise of excellence in personalized customer service. Our more than 3,100 ...
-
commercial hub
hace 4 días
First BanCorp San Juan, Puerto RicoCOMMERCIAL HUB ADMINISTRATION AND SYSTEM ANALYST · Our Company · At FirstBank PR , we strive to be a trusted advisor to our clients and our employees are the ones that ensure we deliver on our promise of excellence in personalized customer service. Our more than 3,100 employe ...
-
Internal Auditor
hace 1 día
abarca health San Juan, Puerto RicoWhat 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... · The Financial Planning & Analysis team contains jacks of ...
-
Software Engineer
hace 1 día
abarca health San Juan, Puerto RicoWhat 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. · Software Development at Abarca Health houses a truly innov ...
-
risk analyst
hace 1 día
First BanCorp San Juan, Puerto RicoRISK ANALYST – · CORPORATE CREDIT RISK MANAGEMENT – · FIRSTBANK PR · Our Company · At FirstBank PR , we strive to be a trusted advisor to our clients and our employees are the ones that ensure we deliver on our promise of excellence in personalized customer service. Our more ...
-
Cyber Incident Response Specialist
hace 10 horas
El Comeback San Juan, Puerto Rico***El Comeback is a non-profit program from ConPRmetidos that attracts and retains professional talent for Puerto Rico-based jobs. Register at to get matched with professional opportunities on the island. Candidates' searches for positions posted by El Comeback are done on behal ...
-
comm credit analyst
hace 1 día
First BanCorp San Juan, Puerto RicoCOMMERCIAL CREDIT ANALYST - CORPORATE BANKING · Our Company · At FirstBank PR , we strive to be a trusted advisor to our clients and our employees are the ones that ensure we deliver on our promise of excellence in personalized customer service. Our more than 3,100 employees i ...
-
Financial Analyst
hace 10 horas
abarca health San Juan, Puerto RicoIn 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... · The Financial Planning & Analysis team safeguards the financial health of Ab ...
-
corporate reporting manager
hace 2 días
First BanCorp San Juan, Puerto RicoCORPORATE REPORTING MANAGER · Our Company · At FirstBank PR , we strive to be a trusted advisor to our clients and our employees are the ones that ensure we deliver on our promise of excellence in personalized customer service. Our more than 3,100 employees in Puerto Rico, the ...
-
consumer credit analyst
hace 4 días
First BanCorp San Juan, Puerto RicoCONSUMER CREDIT ANALYST · AUTO CREDIT ORIGINATION DEPARTMENT · Our Company · At FirstBank PR, we strive to be a trusted advisor to our clients and our employees are the ones that ensure we deliver on our promise of excellence in personalized customer service. Our more than 3,1 ...
-
consumer credit analyst
hace 4 días
First BanCorp San Juan, Puerto RicoCONSUMER CREDIT ANALYST · AUTO CREDIT ORIGINATION DEPARTMENT · Our Company · At FirstBank PR, we strive to be a trusted advisor to our clients and our employees are the ones that ensure we deliver on our promise of excellence in personalized customer service. Our more than 3,1 ...
-
Grant Analyst
hace 1 día
Tetra Tech San Juan, Puerto RicoTetra Tech is a leading provider of consulting, engineering, and technical services worldwide. Our reputation rests on the technical expertise and dedication of our employees—20,000 people working together across disciplines and time zones to provide smart, sustainable solutions ...
Issue Management Analyst - San Juan, Puerto Rico - abarca health
Descripción
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...
Our Operational Performance team is #All-In on centralizing data to dive through and study as they work on improving operations at Abarca. The Operational Performance team tracks goals and metrics to proactively manage shortfalls and ensure we continuously set and reach the highest standards. That's why performance is part of their name as they help drive both scalability and efficiency across the board
As an Issue Management Analyst you will collaborate with other key functional areas to ensure the quality and integrity of the claims processing system by being responsible for identifying, analyzing, documenting, and reporting issues that may impact client or members. You will support the timely performance and completion of all issue management activities of the organization; specifically, conducting the investigation and documentation of the description, root cause, corrective actions, preventive measures, and reporting of claims processing issues. We count on you to make recommendations for corrective actions and process improvements based on documentary and report reviews and to ensure proper monitoring of post-corrective actions to avoid reoccurrence.
What you'll do
In a few words...
What you're made of
The bold requirements...
Nice to have...
That something extra we ́d love to see...
Physical requirements...
Usuarios de profesión Issue Management Analyst en San Juan
-
JOVANNY PONCIANO
Developer software .NET
-
Ricardo Vaccaro
Entry-Level Cybersecurity