Analyst, Claims Quality

Navitus Health Solutions, LLC

6d•Remote

About The Position

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. ____________________________________________________We are committed to providing equal employment opportunity to all applicants and employees and comply with all applicable nondiscrimination regulations, including those related to protected veterans and individuals with disabilities. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or handicap. Due to growth, we are adding a Claims Quality Analyst to our team. The Claims Quality Analyst is responsible for validating that Med D, Medicaid, and Exchange claims are adjudicating per State/CMS regulations as well as specific client needs. Is this you? Find out more below!

Requirements

Bachelor/Associate Degree in business related field; or equivalent combined education and experience preferred
1 - 3 years related work experience preferably in pharmaceutical claims adjudication systems, retail pharmacy, or in a health plan organization
Participate in, adhere to, and support compliance program objectives.
The ability to consistently interact cooperatively and respectfully with other employees

Responsibilities

Audit claim data for Medicare Part D, Medicaid, and Exchange lines of business to validate their accuracy.
Assist with post-implementation monitoring to validate adjudication-related fixes/enhancements are working as expected.
Assist with Claims Adjudication testing by running test claims.
Work in partnership with the Technical Operations Business Analysts and Product Managers to manage changes to existing processes, including defining requirements, creating/executing test plans, and post-implementation oversight.
Complete tasks associated with the assigned processes, performing appropriate oversight, coordinating the resolution of issues with both internal and external stakeholders, using independent judgement to determine the best resolution
As needed, may require working outside of normal business hours to complete time sensitive processes
Other duties as assigned