Analyst, Claims

Navitus Health Solutions, LLC•,

1d•$51,409 - $61,201•Remote

About The Position

Navitus Health Solutions is seeking an Analyst, Claims to join their 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.

Requirements

Associate's degree or equivalent work experience required.
Basic knowledge of applications used within operational processes for ability to perform tasks with minimal guidance required, typically with less than 1 year of experience.
Participate in, adhere to, and support compliance program objectives.
The ability to consistently interact cooperatively and respectfully with other employees.

Nice To Haves

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)

Responsibilities

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.
Other duties as assigned.