Consultant, Issue Management

Navitus Health Solutions, LLC; United States; Remote; USD 61,000 - 75,000; Full time

Job summary

A health solutions company is seeking an Issue Management Consultant to focus on resolving claim adjudication issues and improving operational efficiency. Ideal candidates will have a Bachelor's degree and 2+ years of experience in root cause analysis within the healthcare industry. The role offers competitive benefits including health insurance, paid time off, and 401K matching.

Benefits

Top 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%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan

Referral Bonus Program – up to $750!

Qualifications

• 2+ years of experience in root cause analysis or issue management within healthcare.
• Experience with RCA tools and methodologies.
• Knowledge of regulatory requirements in PBM.

Responsibilities

• Investigate issues to identify root causes.
• Develop action plans to prevent recurrence of issues.
• Monitor effectiveness of preventative actions.

Skills

Root cause analysis

Issue management

Preventative action planning

Microsoft Office Suite

Claims processing workflows

Education

Bachelor’s degree or equivalent experience

Job description

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

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 anIssue 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

Remote

Location: US