Analyst, Benefit Configuration
Navitus Health Solutions
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Benefits offered by this job
Job summary
Navitus Health Solutions is seeking an Analyst, Benefit Configuration to join our team in the United States. The role ensures configurations align with the CAO team to meet client and member needs by accurately administering benefits within the claim adjudication system.
The position may include after-hours and weekend hours depending on workload. You will work with diverse plan designs and networks to ensure timely adjudication and client satisfaction.
Responsibilities
- Completes scheduled and urgent benefit additions, terminations, and changes timely and accurately to prevent member access to care issues.
- Acquires and maintains a basic level of knowledge and interpretation of multiple adjudication system screens and functions to design configurations.
- Complies with HIPAA, NCPDP and Navitus internal standards for benefit design and configuration.
- Performs quality assurance peer reviews and contributes to root cause analysis of issues.
- Uses workflow tools for troubleshooting and responding to general questions.
- Supports internal customers by participating in client meetings, audits and new program implementations.
Education
Tools
Job description
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. ____________________________________________________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.
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. ____________________________________________________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.
USD $20.19 - USD $23.11 /Hr.
0.00 - Ineligible
M-F 8am to 5pm
ATTENTION: Navitus is only able to offer remote work to residents of Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Jersey, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Tennessee, Texas, Utah, Vermont, Virginia, Washington, Washington DC, Wisconsin.
Navitus Health Solutions is seeking a Analyst, Benefit Configuration to join our team! The Analyst, 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 Analyst, Benefit Configuration configures benefits in the claim adjudication system based on specifications from internal customers and external clients. This role applies knowledge of highly diverse plan designs, formularies, and networks across multiple lines of business, ensuring that claims adjudicate accurately and timely.
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!
- Completes scheduled and urgent benefit additions, terminations, and changes timely and accurately to prevent member access to care issues, missed performance guarantees and potential liquidated damages.
- Acquires and maintains a basic level of knowledge and interpretation of multiple adjudication system screens and functions on a field-by-field level to design both standard and custom configurations to meet client expectations.
- Complies with standards set forth regarding benefit design and configuration including HIPAA, NCPDP and Navitus internal business standards.
- Performs quality assurance peer reviews and uses sound business judgment and expertise to contribute toward the creation of root cause analysis of issues.
- 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 setup questions and providing guidance to other areas and roles on the benefit configuration 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 team members.
- Participate in, adhere to and support compliance and diversity, equity, and inclusion program objectives.
- Other duties as assigned.
- Associate’s degree or equivalent work experience required
- Minimal experience and/or training to begin learning skills, systems, and processes of the role with ability to perform tasks with close supervision
- Basic experience with Microsoft Office, specifically Word and Excel
- Participate in, adhere to, and support compliance program objectives
- The ability to consistently interact cooperatively and respectfully with other employees
- 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!
Remote
US
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