Navitus

Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other.

USD $19.60 - USD $21.26 /Hr.

M-F 8am to 5pm

ATTENTION: We are unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.

Navitus Health Solutions is seeking a Benefit Configuration Analyst to join our team! 

 

This position ensures efforts are in alignment with the Claim Adjudication Operations (CAO) team to leverage technology and process improvement for the purpose of meeting the business needs of Navitus customers, clients, members, and pharmacies by accurately administering benefits. The Benefit Configuration Analyst configures benefits in the claim adjudication system based on specifications from internal customers and external clients. This role applies knowledge of highly diverse plan designs, formularies, and networks across multiple lines of business, ensuring that claims adjudicate accurately and timely. Individuals in this role must use sound business judgement and demonstrate the ability to continually prioritize tasks, as customer experience and client financials are directly influenced by their quality of work.

 

This position may include after-hour and/or weekend hours with other eligible team members depending on workload.

 

Is this you? Find out more below!

• Completes scheduled and urgent benefit additions, terminations, and changes timely and accurately to prevent member access to care issues, missed performance guarantees and potential liquidated damages
• Acquires and maintains a basic level of knowledge and interpretation of multiple adjudication system screens and functions on a field-by-field level to design both standard and custom configurations to meet client expectations
• Complies with standards set forth regarding benefit design and configuration including HIPAA, NCPDP and Navitus internal business standards
• Performs quality assurance peer reviews and uses sound business judgment and expertise to contribute toward the creation of root cause analysis of issues
• Uses departmental workflow management, issue resolution and reporting tools for troubleshooting and responding to general customer questions and issue resolution requests
• Contributes to the creation and ongoing maintenance of departmental training materials, work instructions and policies
• Conducts system enhancement and regression testing of a low to moderate level of complexity for benefit configuration processes to ensure compliance with state, federal and client regulations/standards
• Other duties as assigned

What our team expects from you?

• Associate degree or equivalent work experience
• Basic experience with Microsoft Office, specifically Word and Excel
• Participate in, adhere to, and support compliance program objectives
• The ability to consistently interact cooperatively and respectfully with other employees

 

We are unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.

1025 West Navitus Dr. 

Appleton

WI

54913

US