Analyst III, Network Configuration

Navitus Health Solutions, LLC•,

9d•$54,236 - $64,567•Remote

About The Position

Navitus is adding an Analyst III, Network Configuration to its team. The role supports the Provider Services team by using technology and process improvement to meet the business needs of Navitus customers, clients, members, and pharmacies through accurate network administration. The Analyst configures pharmacy networks in the claim adjudication system according to internal specifications and external client requirements, applying knowledge of diverse networks across multiple lines of business to support accurate, timely claims adjudication. The position works closely with Account Management, Claim Adjudication Operations, Formulary Operations, Information Technology, and other departments to support adaptable pharmacy network designs and accurate claims adjudication amid ongoing changes in the pharmacy benefit industry. The work schedule is Monday through Friday, 8 a.m. to 5 p.m. The position may also include after-hours and/or weekend work depending on workload. Remote work is available only to residents of the listed eligible states and Washington, DC.

Requirements

Associate’s degree or equivalent work experience.
Typically 2–3 years of experience, with strong knowledge of Navitus systems and processes and the ability to work independently, follow instructions, and make decisions.
Experience guiding and educating associates in current or lower-level roles.
Experience supporting mid-sized to large clients with moderate to high complexity.
Experience supporting health plan business with minimal guidance.
Intermediate to advanced experience with Navi-ClaimRx.
Intermediate to advanced experience with Microsoft Office, including Word, Excel, and PowerPoint.
Intermediate to advanced experience with Formulary Management.
Intermediate to advanced experience with Request Management tools, including Connectus, Service Desk, and Responsive.
Intermediate to advanced experience with Government Programs Error Management (GEMS).
Intermediate to advanced experience with reporting tools, including 3D QlikView/QlikSense.
Participate in, adhere to, and support compliance program objectives.
Consistently interact cooperatively and respectfully with other employees.

Responsibilities

Complete scheduled and urgent configuration for new client implementations and network additions, terminations, and changes accurately and on time to prevent member access-to-care issues, missed performance guarantees, and potential liquidated damages.
Maintain advanced knowledge of adjudication system screens and functions, designing standard and custom configurations to meet client expectations.
Follow network design and configuration standards, including HIPAA, NCPDP, and Navitus internal business standards.
Perform accurate quality assurance peer reviews of network plan additions and changes; research root causes, troubleshoot resolutions, and recommend corrective actions.
Use departmental workflow management, issue resolution, and reporting tools to troubleshoot and respond to complex customer questions and issue-resolution requests.
Support internal customers by participating in client meetings, audits, and new program implementations, answering network setup questions, and guiding other teams and roles on the configuration process.
Adapt to industry changes and evolving technology while maintaining advanced knowledge of legacy and emerging products and systems.
Lead process improvement, cost reduction, and automation efforts; assess future business needs and make recommendations to leadership.
Contribute to the creation and maintenance of departmental training materials, work instructions, and policies.
Support client and sales presentations and respond to assigned RFP questions using subject matter expertise.
Perform other duties as assigned.