Abarca Health

Title: Data Integration Manager Location: Remote USA Job Description: 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... The Data Integration Manager serves as the primary subject matter expert for client data exchange processes, ensuring seamless integration between client systems and internal platforms. This role combines technical expertise in data architecture, ETL processes, and SQL development with strong client-facing communication skills to deliver high-quality, timely solutions for complex healthcare data needs. This role formally owns data quality for the clients supported, including defining, enforcing, and continuously improving data quality standards across completeness, timeliness, and accuracy. This role proactively manages data anomalies, validates end-to-end flows, and ensures all client deliverables meet contractual and operational expectations, providing strong risk and value-based consultation to clients; effective escalation and relationship management; predictable, accurate data movement, rapid issue resolution, and continuous improvement. The fundamentals for the job… - Own the end-to-end client data exchange lifecycle: discovery, mapping, testing, cutover, steady state, and optimization for recurring eligibility, claims, accumulators, and related feeds. - Formally own data quality standards across completeness, timeliness, and accuracy for all assigned clients; define controls and continuously monitor adherence - Lead client technical workshops to elicit requirements, clarify business rules and use cases, and align acceptance criteria; convert outcomes into user stories, acceptance tests, and implementation plans. Translate client needs into functional requirements and design specifications. - Design and maintain source-to-target mappings with clear transformation rules, value sets, and error handling; track data lineage and maintain version control of layouts/specs. - Build, monitor, and continuously improve controls (file/record counts, totals/hashes, tolerance bands, reject thresholds) and SLA dashboards; proactively remediate risks before SLAs are impacted. - Serve as the primary client-facing owner for data integration performance, ensuring proactive communication, risk mitigation, and timely resolution of issues, including structured management of escalations when necessary. - Provide strategic consultation leveraging business sense—framing issues and recommendations through risk (frequency, financial impact) and value (ROI) considerations. - Apply a product delivery and change-management framework to ensure seamless deployment and adoption of new integrations, file layouts, or client-driven enhancements - Author and optimize advanced SQL for data validation, reconciliation (e.g., member counts, coverage spans, accumulator rollups), sampling, and anomaly detection. - Partner cross-functionally with Product and Engineering on enhancements, release readiness, and client enablement. - Forecast and track delivery progress, risks, and dependencies; maintain transparent reporting. - Mentor team members on standards, best practices, and operational excellence. What we expect of you The bold requirements… - Bachelor’s degree or master’s degree in a quantitative or analytical discipline. (In lieu of a degree, equivalent relevant work experience may be considered.) - 8+ years of experience in healthcare data integration, PBM/health plan data exchange, or related roles - Proven expertise in SQL and relational databases - Experience with dashboarding tools or Python for data analysis (e.g., validation frameworks, reconciliation scripts, data quality checks, file parsing) - Flexibility to support on-call rotations and time-critical deliverables when required - Strong client-facing communication and stakeholder management skills - We are proud to offer a flexible hybrid work model which will require certain on-site workdays (Puerto Rico Location Only) - Availability for on-call rotation for time-critical deliverables. - Ability to work in required time zones aligned with client operational needs. 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-MH1

• Manage all incoming calls, emails, faxes and web-generated requests from pharmacies, beneficiaries, and prescribers. • Provide service-level standards set by CMS or by client; 80% of calls should fall within service level, less than 5% abandon rate and speed to answer should be less than 30 seconds. • Rejection support, including overrides. • Provide Coverage Determination status to clients including exceptions and appeals. • Administrative PAs- Document PA request inquiries, issues, status, and resolution in accordance with federal and department and company policies and guidelines. • Answer questions and recommend corrective services to address customer complaints, payment status, manual reversal requests, benefit and eligibility support, provider portal support and response to price appeals. • Report identified issues to the appropriate department, for investigation and correction, following the established procedure.

• Collect accurate and timely information relevant to bid specifications and platforms from subject matter experts. • Support proposal development to meet on-time delivery. • Ensure proposals present Abarca in a manner that differentiates the company and articulates its value proposition. • Lead and coordinate large, complex projects related to bid completion. • Act as liaison to internal stakeholders regarding bid opportunities and process roadblocks. • Write and edit all delegated proposals from start to finish. • Maintain and enhance knowledge of company and processes to create compelling content. • Collaborate with key Subject Matter Experts (SMEs) to improve proposal content. • Edit and revise proposals according to feedback. • Demonstrate expertise in functional areas to inform responses. • Work with internal SMEs to develop proposal content based on products and services. • Review products and services to package content persuasively for prospects. • Attend and lead meetings as needed for proposal execution. • Help maintain the response repository and manage documentation.

• Be the subject matter expert for one to two product domains within Abarca. • Create, update, enhance, or refine business requirements, user stories and acceptance criteria in an agile framework. • Assist and partner with other Product Owners and Product Managers in solving business needs through collaborative product feature enhancements. • Gather requirements with internal clients and technology teams to solve complex business needs and translate ideas into requirements. • Work collaboratively with business partners, SMEs, Developers, and Testers to ensure a shared understanding of business requirements. • Determine feasibility of business requirements and recommend changes to support business needs and processes. • Assist in analyzing business solution options by evaluating current system processes and identifying possible solution options for new functionality or modifications to existing functionality. • Provide support for your product domain in research, analysis and troubleshooting related to your products. • Provide input and engage in setting priorities to define a product roadmap working with other product owners and product managers. • Understand the products that you own and how they interact upstream and downstream within the product ecosystem. • Ensure that system solution options are thoroughly researched, analyzed, and documented. • Develops acceptance criteria and leads User Acceptance Testing (UAT) efforts to ensure the product meets the needs of the business. • Provide support to Applications Development through participation in Design Reviews. • Project estimates and resource plans for systems solutions.

• Serve as the primary support for pharmacy network and pricing configuration, including network setup, contracted rates, and pricing rules for new client implementations and existing plan changes. • Configure and maintain pricing logic to ensure accurate claims adjudication aligned with client documentation and contractual requirements. • Support configuration changes related to pharmacy network participation and pricing structures across multiple lines of business. • Perform unit testing to validate adjudication outcomes against expected network and pricing rules. • Perform Quality Control and Quality Assurance reviews to ensure accuracy and consistency within network and pricing configuration processes. • Participate as needed in UAT testing for product enhancements/updates to confirm operational and business user acceptance. • Research and resolve claims adjudication issues related to network participation and pricing discrepancies, including root cause analysis, impact assessment, and corrective actions. • Provide first-tier triage support for network and pricing-related claims processing issues, ensuring performance aligned to SLAs/SLOs. • Take ownership of project-based configuration work, ensuring timelines, deliverables, and outcomes are met. • Collaborate across configuration, adjudication, product, and operational teams to execute accurate network and pricing solutions. • Identify network and pricing functionality required to meet client outcomes and support implementation execution. • Continuously develop and maintain an in-depth understanding of Darwin (proprietary adjudication platform) logic related to network and pricing configuration. • Stay current with Medicare, Medicaid, and state regulatory requirements, ensuring configurations remain compliant. • Provide consultation and peer review for network and pricing configuration practices and design standards. • Support the Sr. Analyst in documenting client plan standards, configuration processes, and operational procedures. • Evaluate network and pricing workflows and recommend process improvements that advance efficiency, consistency, and quality outcomes. • Support onboarding and knowledge transfer by contributing to documentation and training resources as needed.