569 Benefit Manager jobs in the United States

Whatyou'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 Quality Assurance Analyst, you'll be the go-to person for answers and prompt solutions, guaranteeing high quality continues to distinguish our technological platforms. You will be responsible for performing tests and monitoring activities as part of projects, new client implementations and/or new functional requirements implementations, ensuring the quality of the systems and processes that support the company's operation. You will be tasked with understanding business requirements and technical specifications, identifying, and defining testing scenarios, and creating, executing, and documenting test cases/scripts conducted to existing functionalities, as well as to new features and/or fixes deployed to our systems.

The fundamentals for the job.

• Serve as a subject matter expert (SME) on all lines of business (Medicare, Medicaid, commercial, etc.) and stay current with regulatory guidelines, ensuring testing complies with rules and regulations.
• Design testing documentation templates and testing scope as required by new client implementations.
• Develop, document, and execute test plans, and test cases and/or scripts based on business requirements.
• Conduct peer reviews of testing results and documentation to ensure the quality of the work.
• Complete analysis, documentation, and reporting to both internal and external stakeholders.
• Create and support client facing, and executive summary materials and discussions as required.
• 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.
• Engage in business requirement gathering process; providing feedback to ensure that the requirements are well-defined and testable.
• Adhere to all current and future company processes as well as specific Quality Assurance validation processes.
• Create and maintain draft SOPs (Standard Operating Procedure) related to testing and quality activities and assist in the ongoing maintenance of said SOP's
• Provide feedback to improve defect trends and engage in testing escape analysis.
• Lead and develop others by actively sharing your direction, expectations, insights, and experiences with team members through daily interactions and mentoring.
• Lead development of innovative ideas that resolve or accelerate the resolution of testing and system issues
• Identify through testing results to improve current systems and drive associated outcomes through collaboration with appropriate departments.
• Actively participate in projects and new client implementations to gather understanding on 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.
• 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.

What we expect of you

The bold requirements.

• Associate's Degree or Bachelor's Degree in Business, Engineering, Healthcare, or related field. (In lieu of a degree, equivalent relevant work experience may be considered.)
• 3+ years of experience or equivalent 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 in spotting patterns, trends, and discrepancies in datasets through problem solving.
• Experience in analyzing large data sets through 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-sitework 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 and quality assurance.
• Experience with pharmacy benefit management operational standards and processes, Medicare Part D, and 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.

#LI-REMOTE #LI-TA1