Note: The job is a remote job and is open to candidates in USA. Navitus Health Solutions is committed to making medications more affordable through innovative pharmacy benefit management. They are seeking a Claims Quality Analyst who will be responsible for validating claims in accordance with State/CMS regulations and client needs, while also assisting with claims adjudication testing and process improvements.
Responsibilities
- 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
Skills
- 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
Benefits
- 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!
Company Overview
Navitus Health Solutions LLC is a full service, URAC-accredited pharmacy benefit management company. It was founded in 2003, and is headquartered in Appleton, Wisconsin, USA, with a workforce of 1001-5000 employees. Its website is https://www.navitus.com/.