Consultant, Issue Management

Navitus Health Solutions; Madison (WI); Remote; USD 61,000 - 75,000; Full time

Job summary

A healthcare solutions provider in Madison, WI is seeking a full-time Consultant for Issue Management. The role focuses on resolving claim adjudication issues and requires 2+ years of experience in the healthcare industry with root cause analysis expertise. This position offers competitive pay ranging from $61,968 to $74,660 annually with comprehensive benefits including health insurance and paid time off.

Benefits

Health, Dental, and Vision insurance

20 days paid time off

401K company match of up to 5%

Flexible Spending Account

Educational Assistance Plan

Qualifications

• 2+ years of experience in root cause analysis, issue management, and preventative action planning within the PBM or healthcare industry.
• Demonstrated knowledge of claims processing workflows, systems, and procedures, including adjudication, resolution, and documentation standards.
• Knowledge of regulatory requirements and industry standards in PBM.

Responsibilities

• Investigate issues to identify underlying root causes.
• Document findings and produce comprehensive RCA reports.
• Develop and implement action plans to prevent recurrence of issues.
• Collaborate with internal teams to refine RCA and preventative action methodologies.

Skills

Root cause analysis

Issue management

Preventative action planning

Claims processing workflows

Microsoft Office Suite

Education

Bachelor's degree or equivalent work experience

Tools

RCA tools and methodologies

Job description

Consultant, Issue Management

Location

US-

ID

2025-5082

Category

unsure

Position Type

Full-Time

Remote

Yes

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 $61,968.00 - USD $74,660.00 /Yr.

Work Schedule Description (e.g. M-F 8am to 5pm)

M-F 8am to 5pm CT

Remote Work Notification

ATTENTION: 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.

Overview

Due to growth, we are adding an Issue Management Consultant to our CAO Quality department.

The Issue Management Consultant plays a critical role in identifying, analyzing, and resolving claim adjudication issues to ensure accuracy, compliance, and operational efficiency. This position focuses heavily on claims reprocessing, risk mitigation, and requirement documentation, serving as a key liaison between internal business units and external clients.

Is this you? Find out more below!

Responsibilities

How do I make an impact on my team?

Investigate issues to identify underlying root causes.
• Apply RCA methodologies such as the 5 Whys to uncover systemic problems.
• Document findings and produce comprehensive RCA reports.
• Develop and implement action plans to prevent recurrence of issues.
• Monitor the effectiveness of preventative actions and adjust as needed.
• Integrate preventative strategies into broader quality improvement initiatives.
• Maintain detailed records of issues, actions taken, and outcomes.
• Provide oversight of remediation efforts to ensure completeness and accuracy.
• Manage end-to-end issue tracking and testing to validate resolution.
• Identify opportunities for process improvement based on RCA findings.
• Collaborate with internal teams to refine RCA and preventative action methodologies.
• Write clear, actionable business requirements to support issue resolution and system enhancements.
• Apply knowledge of claims processing workflows, systems, and procedures, including adjudication, resolution, and documentation standards, to ensure accuracy and compliance
• Other duties as assigned

Qualifications

What our team expects from you?

• Bachelor's degree or equivalent work experience required
• 2+ years of experience required in root cause analysis, issue management, and preventative action planning within the PBM or healthcare industry
• Experience with RCA tools and methodologies
• Demonstrated knowledge of claims processing workflows, systems, and procedures, including adjudication, resolution, and documentation standards is required
• Proficiency in Microsoft Office Suite
• Knowledge of regulatory requirements and industry standards in PBM
• 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?

• 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!

#LI-Remote

Location : Address

Remote

Location : Country

US