Associate Financial Operations Analyst

• Billing and Payment Processes: Execute client billing and provider payment processes, manage invoice submissions and payment issuances, oversee Direct Member Reimbursements (DMRs), execute changes in payment configuration to pharmacies including bank accounts, central payment and address and resolve billing and payment inquiries.
• Compliance and Appeals: Ensure compliance with timeliness requirements for pharmacy appeals, handle pharmacy appeals, and support client and pharmacy concerns.
• Financial Analysis and Reporting: Identify opportunities for process improvement, review and analyze financial discrepancies, contribute to Medicare reporting requirements, and support other reporting requirements for various business lines.
• Cross-Functional Collaboration: Collaborate with other departments to address financial reporting needs and provide support to different departments such as, but not limited to the Product Network Strategy, Product, Software Engineering, Analytics, Data Warehouse, Data Exchange and Darwin configuration team.
• Special Projects and Ad-Hoc Analyses: Assist in the development of ad-hoc analyses and reports, document reporting requirements for Business Intelligence, and support special projects and activities.
• Client and Pharmacy Support: Provide accurate responses to pharmacies, third party providers, and pharmacy services administration organizations and clients.

• Bachelor's degree in accounting, Business Administration, Finance, Pharmacy Technician or a related field (equivalent relevant work experience may be considered).
• 1+ years of experience in Pharmacy Network Management, Finance, Analytical, Client Services, Auditing or Health Industry roles.
• Proficiency in working with financial reports and data analysis tools such as Microsoft Excel, Tableau or similar reporting and analytics tools.
• Strong attention to detail, with a proven ability to identify and resolve financial discrepancies.
• Experience with client-facing issue management effectively.
• Excellent oral and written communication skills, bilingual fluency in Spanish and English is required.
• We are proud to offer a flexible hybrid work model, with on-site work required at our Puerto Rico location.
• 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).

• Current and Active Pharmacy Technician License.
• Experience with Pharmacy Benefit Management industries, Health Insurance Claim Processing, Medicare Part D and CMS regulations.
• Experience or knowledge working with SQL.

• Must be able to access and navigate each department at the organization's facilities.
• Primarily sedentary work, with frequent sitting or standing.

Abarca Health