Tester, Benefit Configuration

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 $19.60 - USD $23.06 /Hr.

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 Tester, Benefit Configuration to join our CAO Support department! 

 

The Tester, Benefit Configuration 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 primary functions of the Tester, Benefit Configuration involve performing and documenting benefit configuration testing ensuring Navitus maintains an accurate, efficient, and versatile claims adjudication system. This position develops tactical tasks and processes to incorporate client and company initiatives into testing to ensure the integrity of pharmacy claims processing.

 

The Tester, Benefit Configuration will work closely with several Navitus roles and departments including, but not limited to, Benefit Configuration, Implementation, Account Management and Government Programs to ensure Navitus is able to provide complete and accurate testing of benefit designs and claims adjudication to adapt to the continuous changes in the pharmacy benefit industry.

 

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? 

• Completes scheduled and urgent benefit configuration testing of new client implementations and/or benefit additions, terminations, and changes timely and accurately to mitigate the risk of member access to care issues, missed performance guarantees and potential liquidated damages.
• Acquires and maintains a basic level of understanding of Navitus’ claims adjudication system and upstream/downstream processes to test both standard and custom configurations to meet client expectations.
• Uses sound business judgment and expertise to contribute toward the creation of root cause analysis of issues.
• Complies with standards set forth regarding benefit design and configuration testing including HIPAA, NCPDP and Navitus internal business standards.
• Uses departmental workflow management, issue resolution and reporting tools for troubleshooting and responding to general 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 testing questions and providing guidance to other areas and roles on the benefit configuration testing process.
• Adapts to industry changes and evolving technology, maintaining a basic level of understanding of both legacy and emerging products and systems.
• Independently assesses business needs and participates in process improvement, cost reduction and automation efforts.
• 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.
• Contributes to training and maintains a mentoring relationship with new and existing benefit configuration testing team members.
• Participate in, adhere to and support compliance and diversity, equity, and inclusion program objectives.
• Other duties as assigned.

Qualifications

What our team expects from you?

• Educa