Analyst, Benefit Configuration
United States
Company
NavitusAbout 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 $19.60 - USD $21.26 /Hr.Work Schedule Description (e.g. M-F 8am to 5pm)
M-F 8am to 5pm CSTRemote Work Notification
ATTENTION: Navitus is unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.Overview
Due to growth, we are adding an Analyst, Benefit Configuration to our CAO Government Programs 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 Benefit Configuration Analyst 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.
Is this you? Find out more below!
Responsibilities
- Completes scheduled and urgent 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 a basic 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 and uses sound business judgment and expertise to contribute toward the creation of root cause analysis of issues
- Uses departmental workflow management, issue resolution and reporting tools for troubleshooting and responding to general customer questions and issue resolution requests
- Contributes to the creation and ongoing maintenance of departmental training materials, work instructions and policies
- Conducts system enhancement and regression testing of a low to moderate level of complexity for benefit configuration processes to ensure compliance with state, federal and client regulations/standards
- Other duties as assigned
Qualifications
What our team expects from you?
- Associate degree or equivalent work experience
- Basic experience with Microsoft Office, specifically Word and Excel
- Participate in, adhere to, and support compliance program objectives
- The 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!
#LI-Remote
Location : Address
RemoteLocation : Country
US ApplyJob Profile
Hawaii Maine Mississippi New Hampshire New Mexico No remote work for residents of Alaska No remote work for residents of Hawaii No remote work for residents of Maine No remote work for residents of Mississippi No remote work for residents of New Hampshire No remote work for residents of New Mexico No remote work for residents of Rhode Island No remote work for residents of South Carolina No remote work for residents of South Dakota No remote work for residents of West Virginia No remote work for residents of Wyoming Rhode Island South Carolina South Dakota West Virginia Wyoming
Benefits/Perks20 days paid time off 401k company match 401(k) match 4 weeks 4 weeks paid parental leave 9 Paid Holidays Adoption Assistance Creativity Dental Dental Insurance Diversity Educational Assistance Flexible Spending Account Health Health insurance Paid holidays Paid parental leave Paid Time Off Parental leave Referral Bonus Remote work Vision Insurance
Tasks- Complete benefit additions and changes
- Conduct system testing
- Configure benefits in claim system
- Create and maintain training materials
- Ensure compliance
- Ensure compliance with regulations
- Issue resolution
- Perform quality assurance reviews
- Process Improvement
- Troubleshoot and resolve issues
Analysis Benefit configuration Business Judgment Claim adjudication Compliance Creativity Customer Experience Customer service Excel Health HIPAA Insurance Issue Resolution Microsoft Excel Microsoft Office Microsoft Word NCPDP Pharmacy Process Improvement Quality Assurance Regulatory Compliance Reporting Root Cause Analysis System testing Testing Training Training material development Troubleshooting Word Workflow Management
Experience0 years
EducationAssociate degree Business Equivalent work experience Quality Assurance Training
TimezonesAmerica/Anchorage America/Chicago America/Denver America/Los_Angeles America/New_York Pacific/Honolulu UTC-10 UTC-5 UTC-6 UTC-7 UTC-8 UTC-9