Sr. Analyst, Claim Payment Accuracy

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._____________________________________________________________________________________________________________________________________________________________________________________________________________. Current associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities.

Pay Range

USD $52,656.47 - USD $62,686.28 /Yr.

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

M-F 8am to 5pm

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

Navitus Health Solutions is seeking a Senior Analyst, Claim Payment Accuracy to join our Government Programs Technical Ops Team!

 

The Senior Analyst, Claim Payment Accuracy is responsible for validating that Med D, Medicaid, and Exchange claims are adjudicating per State/CMS regulations as well as specific client needs. This individual will also be responsible for providing training, direction, and oversight to Technical Operations Analysts assisting with claim payment accuracy auditing.

 

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
• Provide training, direction, support, and oversight to Technical Operations Analysts who are assisting with claim auditing
• Identify claim universes for assigned targeted audits
• Assist with post-implementation monitoring to validate adjudication-related fixes/enhancements are working as expected
• Ensure claims auditing metrics are maintained
• Assist with Claims Adjudication testing by identify existing members/claims to run, identifying test case data points (NPS, NDCs, etc.), creating test files, and running test claims
• Provide technical expertise to facilitate training, create and maintain documentation, and provide ongoing support of assigned Medicare D operational processes
• 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
• Request/run reports and analyzes data to identify or further define issues and provide ongoing quality assurance
• Other duties as assigned

Qualifications

What our team expects from you?

• Bachelor’s/associate degree in business related field or equivalent combined education and experience required
• 3 to 5 years’ experience in one or more of the following: Healthcare Insurance, Pharmaceutical, customer service, data analysis, or equivalent experience
• 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

Remote

Location : Country

US