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 $42,505.00 - USD $50,601.00 /Yr.
Work Schedule Description (e.g. M-F 8am To 5pm)
M-F 7:30am-4:30pm, CST
Overview
Navitus Health Solutions is seeking a Claims Quality Analyst to join our team!
The Claims Quality Analyst is responsible for validating that Med D, Medicaid, and Exchange claims are adjudicating per State/CMS regulations as well as specific client needs.
Is this you? Find out more below!
Responsibilities
How do I make an impact on my team?
Audit claim data for Medicare Part D, Medicaid, and Exchange lines of business to validate their accuracy.
Assist with post-implementation monitoring to validate adjudication-related fixes/enhancements are working as expected.
Assist with Claims Adjudication testing by running test claims.
Work in partnership with the Technical Operations Business Analysts and Product Managers to manage changes to existing processes, including defining requirements, creating/executing test plans, and post-implementation oversight.
Complete tasks associated with the assigned processes, performing appropriate oversight, coordinating the resolution of issues with both internal and external stakeholders, using independent judgement to determine the best resolution
As needed, may require working outside of normal business hours to complete time sensitive processes
Other duties as assigned
Qualifications
What our team expects from you?
Bachelor/Associate Degree in business related field; or equivalent combined education and experience preferred.
1 - 3 years related work experience preferably in pharmaceutical claims adjudication systems, retail pharmacy, or in a health plan organization
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 H ealth, D ental, and V ision insurance
20 days p aid t ime o ff
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!
We are unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.
Seniority level
Entry level
Employment type
Full-time
Job function
Quality Assurance
Industries
Hospitals and Health Care
Referrals increase your chances of interviewing at Navitus Health Solutions by 2x