Analyst, Claims Quality

CompanyNavitusAbout UsNavitus - 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. We are committed to providing equal employment opportunity to all applicants and employees and comply with all applicable nondiscrimination regulations, including those related to protected veterans and individuals with disabilities. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or handicap.Pay RangeUSD $42,505.00 - USD $50,601.00 /Yr.STAR Bonus % (At Risk Maximum)5.00 - Salaried Non-Management except pharmacistsWork Schedule Description (e.g. M-F 8am to 5pm)M-F 8am to 5pm CTRemote Work NotificationATTENTION: Navitus is 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.OverviewDue to growth, we are adding a Claims Quality Analyst to 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! ResponsibilitiesHow 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 resolutionAs needed, may require working outside of normal business hours to complete time sensitive processesOther duties as assignedQualificationsWhat our team expects from you? Bachelor/Associate Degree in business related field; or equivalent combined education and experience preferred1 - 3 years related work experience preferably in pharmaceutical claims adjudication systems, retail pharmacy, or in a health plan organizationParticipate in, adhere to, and support compliance program objectives.The ability to consistently interact cooperatively and respectfully with other employeesWhat can you expect from Navitus?Top of the industry benefits for Health, Dental, and Vision insurance20 days paid time off4 weeks paid parental leave9 paid holidays401K company match of up to 5% - No vesting requirementAdoption Assistance ProgramFlexible Spending AccountEducational Assistance Plan and Professional Membership assistanceReferral Bonus Program – up to $750!Location : AddressRemoteLocation : CountryUSOriginally posted on Himalayas