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 $18.67 - USD $21.96 /Hr.

M-F 8am to 5pm

ATTENTION: Navitus is 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 Manual Claims Coordinator to join our team!

 

The Coordinator, Manual Claims 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. This position is responsible for processing of pharmacy and/or direct member reimbursement (DMR) claims of all levels of complexity to execute the claims adjudication process including correction of claims.

 

This position may include after-hour and/or weekend hours depending on workload.

 

Is this you? Find out more below!

How do I make an impact on my team? 

• Accurately processes claims within the claims adjudication system within specified client performance guarantee timeframes, guarding client and Navitus from potentially high dollar financial liabilities
• Acquires and maintains a basic understanding of Navitus’ claims adjudication system, plan designs and upstream/downstream processes. Interprets client specific rules to ensure quality and accuracy of processing
• Manages intake, scanning and categorization of inbound mail. Processes and mails outbound letters to members and pharmacies
• Creates, validates and confirms large batches of claims prior to electronic processing
• Learns and abides by HIPAA and other regulatory requirements to participate in client, compliance, and state/federal audits. Includes compilation of claim files, audit universes, report creation and analysis, validation of claims against benefit allowances and responding to auditor questions verbally and in writing
• Participates in new client implementations and supports existing clients of low to moderate complexity, acting as the representative for manual claims in all related meetings and communications
• Assists in the creation and ongoing maintenance of departmental training materials, work instructions and policies
• Communicates the nature of processing claims with all departments, providing talking points for Member Services to explain claim processing reimbursements to members and pharmacies, and Client Services or Government Programs to explain claim correction outcomes
• 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

 

Remote

US