Analyst, Accumulator Claims Extract-Remote - Appleton, United States - Navitus Health Solutions LLC

Navitus Health Solutions LLC Appleton, United States

2 weeks ago

Description

Job Description

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.

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.

The Analyst, Accumulator Claims Extract 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. Individuals in this role will function as a liaison by gathering, documenting and delivering implementation requirements to all necessary departments for both accumulators and claims extracts, and will act as a back-up resource for peer analysts when needed.

This position requires knowledge of both the technical and operational sides of the business. The Analyst, Accumulator Claims Extract will work closely with Information Technology, Implementation, Benefit Configuration, Accumulator and Eligibility teams to understand the interdependences of each functional area. Individuals in this role will have direct authority to make sound business decisions regarding client accumulator and claims data and will demonstrate the ability to continually prioritize day to day workload to meet individual, departmental and organizational goals.

This position may include after-hour and/or weekend hours depending on workload.

Is this you? Find out more below

How do I make an impact on my team?

Implements and tests client accumulator and claims extract data file processes and services for new clients of low to moderate complexity. This includes understanding client needs, plan designs, standard and custom data file layouts, monitoring of electronic file deliveries and subsequent reports.
Actively participates as a key participant in all assigned new client implementations, sharing subject matter expertise in all lines of business for accumulator and claims extracts during client kick-off and data calls, internal meetings and communications.
Functions as both a business and technical liaison between requesting Implementation team members and Data Services programming resources. Interprets client specific rules, translates data elements, provides technical data mapping specifications to IT programmers and fully validates all changes to ensure quality and accuracy of data files.
Gains a working knowledge of claims processing in order to review processed claims and reversals, plan design, drug tiers and issues new clients or vendors encounter loading Rx claims into their systems.
Uses sound business judgment and reporting expertise to contribute toward the creation of root cause analysis of issues.
Educates others on new client accumulator and claims extract processes, providing talking points to Implementation and Government Programs for client and plan sponsor data discussions.
Independently assesses business needs for process improvements, cost reduction and automation efforts. Brings recommendations to CAO leadership and to the Implementation team during implementation process review meetings.
Adapts to industry changes and evolving technology, maintaining a basic to intermediate level of understanding of both legacy and emerging products and systems.
Contributes to training and maintains a mentoring relationship with new and existing team members in the same role. Assists in the creation and ongoing maintenance of departmental training materials, work instructions and policies.
Conducts system enhancement and regression testing for low to moderately complex accumulator and claims extract related processes to ensure compliance with state, federal and client regulations/ standards.

What our team expects from you?

Associate degree or equivalent work experience
Basic experience with Microsoft Office, specifically Excel and Word
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?

Hours/Location: Monday-Friday 8:00am-4:30pm, CST-Remote
Paid Volunteer Hours
Educational Assistance Plan and Professional Membership assistance
Referral Bonus Program – up to $750
Top of the industry benefits for Health, Dental, and Vision insurance, Flexible Spending Account, Paid Time Off, Nine paid holidays, 401K, Short-term and Long-term disability, College Savings Plan, Paid Parental Leave, Adoption Assistance Program, and Employee Assistance Program

#LI-Remote

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