Supervisor, Claims Reprocessing

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 the Supervisor for Claims Processing, you’ll be responsible for overseeing and supervising a team of individual contributors tasked with the timely and accurate processing of prescription claims.  Claims Processing Supervisor includes within its scope the operational services for Direct Member Reimbursements, Manual Pharmacy Claims, and Subrogation.   This leadership role includes management activities  such as analyzing and preparing work forecasts to support staffing plans, training, coaching, and supporting operational issue management. The supervisor will also drive and support process improvement initiatives and ensure adherence to department standard desktop procedures and SLAs. You will oversee the organization and distribution of work related to manual claims receipt and processing and serve as the main liaison with other departments.

The fundamentals for the job…

• In this role, you will oversee the day-to-day work of a team of individual contributors to deliver PBM Claim Services to members, pharmacies and payers
• Provide input and monitor desired team goals (i.e., OKRs, KPIs, and project deliverables), ensuring your team is delivering accurate and timely results
• Contribute to the development of the team through regular performance assessments, growth conversations, and calibration processes, with support from the Director.
• Actively participates in defining and maintaining standard desktop procedures (SDP) for critical department functions
• Analyzes department data to identify opportunities in process or product improvements to improve department scalability and efficiency
• May lead department related initiatives including new claim service creation which can entail the creation of new processes, and partnering with internal partners to complete system enhancements
• Proactive review of work inventory to optimize resource allocation on a continuous basis
• Performs qualitative review of random claims processed by the team to ensure adherence to SDPs and overall claims accuracy
• Ensure daily tasks related to manual claims processing are adequately distributed between the team members and are completed towards client satisfaction and complaint with regulatory requirements and SLAs
• Mentors and provides feedback to ensure team members are consistently delivering quality and well-timed results in partnership with stakeholders
• Represents the manual claims team in internal and client calls and collaborates with peers for second tier consults
• Develop and deliver progress status reports and hold regular status meetings with team.

What we expect of you

The bold requirements…

• Bachelor’s degree in Computer, Healthcare, Business, or related field. (In lieu of a degree, equivalent, relevant work experience may be considered.)
• 6+ years PBM or Pharmacy Claim Operations experience.
• 3+ years of supervisory experience
• Excellent analytical and problem-solving skills.
• Ability to establish good interpersonal skills.
• Excellent oral and written communication skills.
• We are proud to offer a flexible hybrid work model which will require certain on-site workdays (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 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 have…

• Experience working with SQL and Excel tools.
• Knowledge of Medicare and Medicaid.
• Bilingual: English/Spanish

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.  “Applicant must be a United States’ citizen or Permanent Resident. 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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