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WE ARE THE FUEL THAT KEEPS THE ENGINES OF ABARCA RUNNING!

We make sense of a complex healthcare system, constantly pursuing new concepts and innovative ideas. In short, we make things happen and have fun doing it!

WHAT WE DO

SERVICE OPERATIONS

  • Manage pharmacy networks and all customer service functions for pharmacies, physicians and beneficiaries/members.
  • Provide strategic direction, key programs, and continuous updates to ensure a high quality of service to clients.
  • Oversight of pharmacy networks to comply with CMS Network and Member.

CLINICAL SERVICES

  • Evaluate coverage determination requests.
  • Develop and execute clinical programs.
  • Educate clients and pharmacies on new drugs approved and other clinical happenings.
  • Support clients in all clinical-related activities and requests.

QUALITY

  • Monitor that claims are adjudicating according to the client’s requirements.
  • Document, communicate, and coordinate resolution and preventive measures of any claim issues identified through claims monitoring or reported by client, member or other Abarca department.
  • Perform configuration testing, and lead the defect management process during a new client implementation to ensure a successful go-live.

DARWIN CONFIGURATION & IMPLEMENTATION

  • Manage benefits, formulary and/or network requirements.
  • Configure requirements in the PBM platform.
  • Fully validate and test configured requirements.
  • Actively participate as new enhancements affecting configuration arise.
OPENINGS in Operations
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