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 $58,460.48 - USD $70,434.33 /Yr.

M-F 8 am - 5 pm

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 SIU Analyst I to join our team!

 

The SIU Analyst position is responsible for conducting moderate to complex research using internal and external databases to perform analyses and develop recommendations on suspected fraud, waste, and abuse related to members, prescribers, pharmacies, and clients. In addition, the Analyst is responsible for regular and proactive extraction and evaluation of mined data, scoping data for investigations, and responding with reports and data for audits, universes, and impact assessments. The Analyst will coordinate and support data requests from third parties regarding fraud, waste, and abuse. The Analyst will also process and assess data produced by vendors, health plans, and third parties for analysis and comparison with Navitus claims. The Analyst will remain current on the regulatory environment and trends associated with fraud, waste, and abuse including changes directly or indirectly impacting Navitus Health Solutions, LLC. The Analyst will also assist the Associate Director, Compliance and SIU with duties related to analytic criteria, data tools, metrics calculation, and reporting of results.

 

Is this you? Find out more below!

How do I make an impact on my team? 

• Under limited supervision perform timely research and analyses to initiate and support investigations and business operations
• Analyze and validate claims data, reports and datasets for value, variance, and content to escalate for investigation of potentially fraudulent trends and patterns
• Evaluate data and report findings for accuracy, completeness, intent, and scope
• Coordinate data from internal databases and/or external data sources
• Track and monitor data, analysis and documentation for retrieval and coordination with investigations
• Develop reports and support clients on fraud, waste, and abuse universe prep and impact analysis
• Maintain tables, tools, or reports associated with data mining, data imports, and universe prep
• Coordinate metrics and performance reporting for fraud, waste, and abuse program activities
• Facilitates and/or participates in process re-design, service improvement, cost reduction and automation
• Other duties as assigned

What our team expects from you?

• Bachelor’s Degree or a combination of education and relevant work experience is required. Pharmacy Technician certification strongly desired. Must be willing and able to work towards professional designations related to analysis and/or investigation of fraud, waste and abuse
• 2-4 years with working data analytics in a healthcare or pharmacy benefits management environment. Knowledge of state and federal privacy laws and protocols a plus. Participate in, adhere to, and support compliance program objectives
• The ability to consistently interact cooperatively and respectfully with other employees

Remote

US