Analyst, Claims

Company

Navitus

About 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 $49,911.36 - USD $59,418.28 /Yr.

Work Schedule Description (e.g. M-F 8am to 5pm)

M-F 8am to 5pm CST

Remote 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, Claims 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 Claims Analyst 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 Claims Analyst 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

How do I make an impact on my team? 

• 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

Qualifications

What our team expects from you?

• Bachelor’s degree or equivalent work experience
• Minimum of four (4) years of experience in NaviClaimRx or other table-based claims processing systems preferred
• 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), and Reporting (3D QlikView/QlikSense)
• 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! 

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