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._____________________________________________________________________________________________________________________________________________________________________________________________________________. Current associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities.

USD $49,911.00 - USD $59,418.00 /Yr.

8 am to 5 pm, CT

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 Claims Analyst to join our team!

 

The Analyst, 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. The Analyst, Claims role is responsible for analyzing, documenting, and reporting findings of claim processing issues. Individuals in this role will interview stakeholders and research claim processing issues within the PBM claim processing system and will use the information to document the “how” and “why” of the claim processing issues.

 

The Analyst, Claims will work closely with benefit configuration analysts to gain an understanding of the benefit design and plan build. This position also collaborates with several Navitus departments including, but not limited to, Account Management, Provider Relations, Formulary Operations, and Information Technology to ensure Navitus is able to provide a versatile adjudication system to adapt to the continuous changes in the pharmacy benefit industry.

 

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!

How do I make an impact on my team? 

• Collaborates with benefit configuration analysts and internal customers using sound business judgement and expertise to research and determine root causes for claim processing issues of low to moderate complexity.
• Works simultaneously on multiple claim processing issues using subject matter expertise to enhance and improve the accuracy of claim processing.
• Acquires and maintains an intermediate to advanced level of knowledge and interpretation of benefit designs and adjudication system screens and functions.
• Applies advanced reporting and data analysis techniques to identify error types, root causes and quantity of claims affected.
• Establishes and utilizes standard templates to document and share a comprehensive summary of findings including a systemic impact analysis with CAO leadership and all relevant functional areas.
• Recommends retraining, new training and/or corrective action plans based on findings and works closely with benefit configuration trainers and coaches to take appropriate action to mitigate future occurrences and financial risk to client and/or Navitus.
• Adapts to industry changes and evolving technology, maintaining an intermediate to advanced level of understanding of both legacy and emerging products and systems.
• Uses departmental workflow management, issue resolution and reporting tools for troubleshooting and responding to moderate to complex customer requests.
• Independently assesses business needs and participates in process improvement, cost reduction and automation efforts.
• Participate in, adhere to and support compliance and diversity, equity, and inclusion program objectives.
• Other duties as assigned.

What our team expects from you?

• Education: Associate’s degree or equivalent work experience required.
• Experience:
  • Basic knowledge of Navitus systems and processes of the role with demonstrated ability to perform task with minimal guidance required, typically with less than 1 year of experience.
  • Experience with supporting mid-sized to large clients with moderate to high complexity.
  • Experience with the following tools at an intermediate to advanced level preferred:
    • Claims Processing
    • Microsoft Office (Word, Excel, PowerPoint)
    • Formulary Management
    • Request Management (Connectus, Service Desk)
    • Reporting (3D QlikView/QlikSense)

 

Remote

US