Returning Candidate? Log back in! Analyst, Claims Location US- ID 2024-3391 Category Administration Position Type Full-Time Remote Yes Company Navitus About Us 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. Pay Range USD $49,911.00 - USD $59,418.00 /Yr. Work Schedule Description (e.g. M-F 8am to 5pm) M-F 8am to 4:30pm CST Overview

Navitus Health Solutions is seeking a Claims Analyst to join our CAO Support department!

 

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 Claims Analyst 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 Claims Analyst 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!

Responsibilities

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 complexityWorks simultaneously on multiple claim processing issues using subject matter expertise to enhance and improve the accuracy of claim processingAcquires and maintains an intermediate to advanced level of knowledge and interpretation of benefit designs and adjudication system screens and functionsApplies advanced reporting and data analysis techniques to identify error types, root causes and quantity of claims affectedEstablishes 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 areasRecommends 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 NavitusAdapts to industry changes and evolving technology, maintaining an intermediate to advanced level of understanding of both legacy and emerging products and systemsUses departmental workflow management, issue resolution and reporting tools for troubleshooting and responding to moderate to complex customer requestsIndependently assesses business needs and participates in process improvement, cost reduction and automation effortsOther duties as assigned Qualifications

What our team expects from you?

Bachelor’s degree or equivalent work experienceMinimum of four (4) years of experience in NaviClaimRx or other table-based claims processing systems preferredExperience 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), and Reporting (3D QlikView/QlikSense)Participate in, adhere to, and support compliance program objectivesThe ability to consistently interact cooperatively and respectfully with other employees

What can you expect from Navitus? 

Top of the industry benefits for Health, Dental, and Vision insurance 20 days paid time off 4 weeks paid parental leave 9 paid holidays 401K company match of up to 5% - No vesting requirement Adoption Assistance Program Flexible Spending Account Educational Assistance Plan and Professional Membership assistance Referral Bonus Program – up to $750! 

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.

 

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