Business Solution Manager (Pharmacy Benefit Management)

Abacus Insights is a mission-driven, start-up technology company focused on transforming the healthcare payer industry, ultimately creating a more personalized patient experience, improving health outcomes, and lowering the overall cost of healthcare. Abacus Insights provides a flexible, efficient, and secure platform that organizes and exchanges healthcare data from various sources and formats, allowing our customers to uncover differentiated insights that address their clients' needs. Our employees know that they play an active role in keeping our customers' data safe and are responsible for ensuring that our comprehensive policies and practices are met.  

With our deep expertise in cloud-enabled technologies and knowledge of the healthcare industry, we have built an innovative data integration and management platform that allows healthcare payers access to data that has been historically siloed and inaccessible. Through our platform, these health insurance payers can ingest and manage all the data they need to transform their business by supporting their analytical, operational, and financial needs.  

Since our founding in 2017, Abacus has built a highly successful SaaS business, raising $100 Million by leading VC firms who have deep expertise in the healthcare and technology industries. We are solving problems of massive scale and complexity in an industry that is not only ready for disruption. We're growing quickly and would love for you to be a part of it!  

About the Role: 

We are seeking an experienced professional with operational and business analysis experience in Pharmacy Benefit Management operations and dataset to join our client solutions team. The successful candidate will lead the requirements gathering, analysis and definition for solutions to support payor clients in the following areas:  

• Pharmacy Benefit Management data acquisition and payor integrations
• Pharmacy Benefit Utilization
• Cost Analysis
• Rebate Tracking and Analysis
• Benefit structures 
• Claims and Payment reconciliation
• Operational processes supporting the aforementioned areas including 

This role requires an analytical thinker with experience in healthcare operations, understanding of the data domain.  The Business Solution Manager must have a proven track record in leading the development of business requirements in a client-based setting.  Qualities required to succeed in this role include understanding the pharmacy data domain, strong cross-functional collaboration skills, and exceptional client engagement acumen. 

You Will: 

• Client Solutions Requirements Management: Develop business requirements in the form of use cases that capture the client’s requirements.  Work with client’s designated subject matter expert to understand business requirements and gather into a Business Requirements Document (BRD).  This may include elaborating on requirements with the client, capturing acceptance criteria, and identifying non-functional requirements.  Requirements scope can vary across a broad range of client deliverables including, but not limited to, reports, dashboards, data extracts or views into the data used by the client for operations or analytics.  
• Operational Expertise: Use your operational experience and knowledge in provider network operations, provider data management, provider credentialing, and healthcare data to triage business requests and requirements.
• Requirements Validation: Perform a set of tests against the delivered solution and confirm all acceptance criteria are met before turning over the solution to the client.  This is a validation step performed by the author of the business requirements with assistance from other team members to simulate the actual client user acceptance testing (UAT) as a precursor to the client’s actual UAT.  This activity compliments core testing performed by the Abacus QA team.  
• User Acceptance Testing: Laise with the client and partner with team members to coordinate and progress the client’s UAT.
• Customer Relationship Management: Partner with Account Management, Program Management, Sales, and Product Management to develop strong customer relationships, resulting in reference customers.
• Collaboration and Coordination: Work closely with cross-functional teams, including business experts, technical business analysts, project managers, account executives and data engineers to successfully implement client projects. Collaborate with Product Management to identify client-specific requirements that may translate into an existing standard product feature or a future feature on the product roadmap.
• Training and Support: Provide training to internal teams on business needs and use cases for seamless customer implementation. Provide ongoing support to address questions and issues raised by the implementation team. 
• Cross-Functional Communication: Serve as a bridge between the client and Abacus technical teams, effectively communicating business requirements to team members.  
• Awareness of Product Capabilities: Become educated and understand the strategy of new product launches, new features, and product upgrades, and how they support the client.
• Process Improvement: Conduct process analysis, process evaluation, and implement process improvements that lead to better solutions and client satisfaction. 

 
What We're Looking For: 

• Bachelor’s degree in Health Care Administration, Computer Science, or other equivalent work experience or training
• Capacity to build and manage working relationships with internal and external team members
• Ability to multi-task and react positively to frequent changes in priorities
• Ability to communicate succinctly and clearly, both verbally and in writing, to technical and non-technical audiences
• Experience with requirements gathering and documentation
• Ability to positively impact process improvement and process management
• High level of project organization, attention to detail, and time management
• High level of motivation to solve existing problems while anticipating new issues
• 5+ years of experience working with Healthcare Administration software 

Nice to Have: 

• Highly organized, self-motivated, and able to complete complex tasks with little supervision
• Strong commitment to remaining current on market needs by participating in educational opportunities, reading professional publications, maintaining personal networks, and participating in professional organizations
• Experience collaborating with internal and external departments to position company products and services competitively to address market and client needs 

Equal Opportunity Employer 

As a mission-led technology company helping to drive better healthcare outcomes, Abacus Insights believes that the best innovation and value we can bring to our customers comes from diverse ideas, thoughts, experiences, and perspectives. Therefore, we dedicate resources to building diverse teams and providing equal employment opportunities to all applicants. Abacus prohibits discrimination and harassment regarding race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.