Job Description

Title: Product Resolution Manager

Location: Remote

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

Our Product Team is the steady bridge between clients and tech teams at Abarca. They lead us towards #PBMAwesome by brainstorming new innovations, improvements and scaling for our product and technology offerings! Attention to detail and observational skills are key in this team to ensure our products are fully functional and maintain quality. Our Product Owners and Managers also ensure all program specifications are correct, business requirements are properly established, and operating procedures are adjusted as needed.

As our Product Resolution Manager, you will be responsible for overseeing and supervising the Product Resolution team. This role will require time on leadership activities including assigning work via ticketing system, training, coaching, and triaging issues for Product and championing solutions to continuously improve the product. You will oversee the organization and distribution of work related to product issues and serve as the main liaison with other departments to ensure issues are resolved timely and accurately.

The fundamentals for the job

  • Provide team leadership and coaching by focusing them on the tasks at hand and/or the internal and external customer requirements.
  • Coordinate team logistics, communicate team status, task accomplishments, and direction.
  • Manage the Product Technical Service Investigations backlog, priorities, escalations, and external communications.
  • Develop, track, and provide Product Issue & Resolution metrics, efforts, and results to business stakeholders and company leads.
  • Supports the implementation process by leading the Product command center, including triaging and reviewing any investigations received and coordinating with product and technical teams as necessary.
  • Bug management works with the individual product team to establish and communicate timelines for completion of bugs.
  • Lead the Product Adjudication issue management process by working with the Product and Engineering teams to produce client-appropriate:
    • Issue Summary
    • Root Cause Analysis
    • Corrective Actions
    • Preventative Measures
    • Impact Criteria
    • Impact Analysis Review and/or Coordination
  • Proactively partners with the Issue Management and Client Success teams to ensure Product issue management deliverables are provided accurately within established timelines and SLA’s.
  • Provides issue management expertise and support, including strategies to respond to issues, and provides advise on best approaches to respond to stakeholder inquiries.
  • Expected to represent Abarca working with clients to explain and/or manage incidents impacting claims adjudication.
  • Perform risk management to ensure remediation plans are in place with the objective of mitigating the financial impact, member access to medication and compliance, among others.
  • Participates in regulatory change management activities and meetings to keep abreast of regulatory changes impacting claims adjudication.
  • Actively participates in Product scrum team meetings to understand changes to the product which may impact issue management activities and to provide SME feedback on potential solutions.
  • Evaluate current system processes and champion solutions for new or enhanced functionality to improve product quality and claims traceability.
  • Contribute to the definition of strategic initiatives to improve the issue management, processes, tools, and reporting capabilities.
  • Contribute to the development and implementation of quality assurance activities such as defining policies & procedures, workflows, and training.
  • Participate in the preparation for CMS, client or internal audits as well as follow through on any corrective actions requiring QA.
  • Create full documentation of actual processes and future processes of the company, departmental policies and procedures, and software application manuals.
  • Prepare extensively detailed documentation of business requirements, use cases, and test cases.
  • Understand the applications supported and their upstream/downstream impact.
  • Determine feasibility of business requirements and recommend changes to support business needs and processes.
  • Work collaboratively with business partners, SMEs, developers, and testers to ensure a shared understanding of business requirements.
  • Ensure that system solution options are thoroughly researched, analyzed, and documented while creating project estimates and resource plans for those solutions.
  • Provide support to Quality Assurance on development of test approaches and to Applications Development through participation in Design Reviews.
  • Perform additional tasks or special projects as assigned.

What we expect of you

The bold requirements

  • Bachelor’s or Master’s Degree (In lieu of a degree, equivalent relevant work experience may be considered.)
  • 8+ years of experience as a product owner, product analyst or in roles associated and/or collaborating with product management within an Agile SDLC environment
  • 7+ years of experience in pharmacy and/or medical claims processing.
  • 6+ years of experience in a leadership role.
  • Experience in project management, client facing tasks, facilitating meetings, and setting priorities.
  • Experience in leveraging and utilizing SQL, business intelligence and associated data analysis tools.
  • Experience utilizing dashboard tools, e.g., Tableau, QVW, and Excel tools.
  • Experience in prioritizing and handling multiple projects at once without missing deadlines.
  • Experience with high capacity for process improvement.
  • Excellent oral and written communication skills.
  • Experience in developing roadmaps, managing product questions, leading meetings and developing technical product documentation.
  • Ability to develop and document acceptance criteria and user stories.
  • Ability to collaborate and work within an agile and scrum environment and with associated SDLC toolsets (example: DevOps, Jira, etc.).
  • Experience with Healthcare, Pharmacy, and Pharmacy Benefit industries, Medicare Part D, and CMS regulations, NCPDP standards and/or HIMSS.
  • 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)

Nice to haves

  • 2 years of experience in pharmacy benefit management is preferred.
  • Scrum Certified Product Owner or Product Strategy Product Owner certification preferred.
  • HIPAA certification, both Security & Privacy; Confidentiality, and Fraud, Waste & Abuse (FWA).
  • Experience with business intelligence solutions to create ad-hoc queries & reports to support analysis.

Physical requirements

  • Must be able to access and navigate each department at the organization’s facilities.
  • Sedentary work that primarily involves sitting/standing.