Sr. Analyst, Benefit Configuration

Navitus Health Solutions, LLC•,

2d•$63,827 - $76,900•Remote

About The Position

Due to growth, we are adding a Sr. Analyst, Benefit Configuration to our team! 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 Sr. Analyst, Benefit Configuration, configures benefits in the claim adjudication system based on specifications from internal customers and external clients. This role applies knowledge of highly diverse plan designs, formularies, and networks across multiple lines of business, ensuring that claims adjudicate accurately and timely. Individuals in this role 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.

Requirements

Associate’s degree or equivalent work experience required.
Full mastery of Navitus systems and processes of the role with ability to perform tasks independently and follow instructions to make decisions required, typically with 4 or more years of experience.
Experience with guiding and educating associates within current to lower-level roles.
Experience with guiding and educating associates within current to lower-level roles.
Experience with supporting highly complex/custom health plan business.
Experience with the following tools at an advanced to expert level: Navi-ClaimRx, Microsoft Office (Word, Excel, PowerPoint), Formulary Management, Request Management (Connectus, Service Desk), Government Programs Error Management (GEMS), Reporting (3D QlikView/QlikSense)
Participate in, adhere to, and support compliance program objectives.
The ability to consistently interact cooperatively and respectfully with other employees.

Responsibilities

Completes scheduled and urgent configuration of new client implementations and/or benefit additions, terminations, and changes timely and accurately to prevent member access to care issues, missed performance guarantees and potential liquidated damages.
Acquires and maintains an expert level of knowledge and interpretation of multiple adjudication system screens and functions on a field-by-field level to design both standard and custom configurations to meet client expectations.
Complies with standards set forth regarding benefit design and configuration including HIPAA, NCPDP and Navitus internal business standards.
Performs quality assurance peer reviews of benefit plan additions and changes with a high degree of accuracy. Researches root cause of issues, troubleshoots viable resolutions and makes recommendations for corrective action.
Uses departmental workflow management, issue resolution and reporting tools for troubleshooting and responding to highly complex customer questions and issue resolution requests.
Supports internal customers by participating in client meetings, audits, and new program implementations with other areas of the company, answering benefit setup questions and providing guidance to other areas and roles on the benefit configuration process.
Adapts to industry changes and evolving technology, maintaining an expert level of understanding of both legacy and emerging products and systems.
Leads process improvement, cost reduction and automation efforts. Independently assesses future business needs and brings recommendations to leadership.
Contributes to the creation and ongoing maintenance of departmental training materials, work instructions and policies. Participates in training and maintains a mentoring relationship with new and existing benefit configuration team members.
Collaborates with IT Business Analysts responsible for writing business requirements for projects and claim system enhancements involving highly complex benefit configuration processes. Conducts comprehensive release and regression testing to ensure quality and compliance with state, federal and client regulations/standards.
Develops content for client and sales presentations, actively participates in client demonstrations and responds to assigned RFP questions using subject matter expertise.
Other duties as assigned.