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 $52,656.47 - USD $62,686.28 /Yr.

M-F 8am to 5pm CST

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.

Due to growth, we are adding an Analyst, Historical Claims to our CAO Client department.  

The Analyst, Historical 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 role is responsible for the establishment and ongoing monitoring of Historical Claim files received from external partners for new and existing clients. The Analyst, Historical Claims position requires knowledge of both the technical and operational sides of the business. 

Individuals in this role will maintain a working knowledge of Historical Claims files and associated formats. This role will partner with development resources to champion the enhancement of current processing to meet both new and existing client needs. This role will also work closely with Customer Success, Implementation, and Data Services to meet client requirements. The Analyst, Historical Claims will have direct authority to make sound business decisions regarding client historical claims data and will demonstrate the ability to continually prioritize day to day workload to meet individual, departmental and organizational goals for service and performance. 

Is this you? Find out more below!  

How do I make an impact on my team?   

• Participates in new client implementations to facilitate intake and loading of historical claims files for internal business processes 
• Analyses vendors’ custom, inbound file layouts, interprets appropriate translation of data elements and prepares data mapping specifications for IT development 
• Triages and monitors ongoing historical claims file loads for existing clients 
• Works directly with client contacts, historical claims vendors and Navitus’ Account Management team and participates as subject matter expert in assigned new client implementations and/or existing client change projects and related meetings and communications 
• Uses self-directed, sound business judgment and expertise to identify, define and formulate root cause analysis of historical claims process issues. Documents results of analysis and makes recommendations for corrective action plans and process improvements 
• Adapts to industry changes and evolving technology, maintaining an advanced level of understanding of both legacy and emerging products and systems 
• Participates in process re-design, service improvement, cost reduction and automation efforts to streamline current historical claims file processes 
• Contributes to the creation, peer review and ongoing maintenance of departmental training materials, work instructions and policies 
• Generates queries and reports to monitor historical claims file loads and identify/troubleshoot issues and fulfills special reports requested by clients, leadership and other departments on an ad hoc basis 
• Educates other roles on historical claims file loading process and responds to customer questions and issue resolution requests 
• May include after-hour and/or weekend hours depending on workload 
• Other duties as assigned 

What our team expects from you? 

• Associate’s degree or equivalent work experience required. 
• Intermediate level of knowledge for systems and processes within the role required
• Experience in historical claims file loads and/or data file management preferred
• Experience with the following tools at an intermediate to advanced level preferred:
  • Claims Processing
  • Microsoft Office (Word, Excel, PowerPoint)
  • Text Editing (Notepad++/UltraEdit)
  • Request Management (Service Desk)
  • Reporting (3D QlikView/QlikSense)
  • FTP File Transfer/Retrieval (FileZilla) 
• Participate in, adhere to, and support compliance program objectives 
• The ability to consistently interact cooperatively and respectfully with other employees 

#LI-Remote

Remote

US