Job Description
Note:
The job is a remote job and is open to candidates in USA. Navitus Health Solutions is dedicated to providing affordable medications and is seeking an Analyst, Claims Extract to enhance their team. This role focuses on managing client claims extract processes while ensuring alignment with the Claim Adjudication Operations team, contributing to technology and process improvements. Responsibilities Oversees, manages and maintains claims extract data processes and services for 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 Interprets client specific rules, translates data elements, provides technical mapping specifications to IT programmers and fully tests all changes to ensure quality and accuracy of extract files Functions as both a business and technical liaison between requesting business areas and Data Services programming resources. Participates in existing client changes of low to moderate complexity, acting as the subject matter expert for claims extracts in all related meetings and communications Collaborates directly with client and/or Client Services team to report data file delivery issues on an agreed upon client schedule Gains a working knowledge of claims processing in order to review processed claims and reversals, plan design, drug tiers and issues clients 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 Independently assesses business needs and participates in process improvement, bolthires reduction and automation efforts Educates others on the claims extract process, providing talking points to Client Services and Government Programs for client and plan sponsor discussions Adapts to industry changes and evolving technology, maintaining a basic to intermediate level of understanding of both legacy and emerging products and systems.
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 claims extract related processes to ensure compliance with state, federal and client regulations/ standards Other duties as assigned Skills 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 Experience on basics and gaining familiarity with the role and company Basic experience with bolthires 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 Benefits 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!
Company Overview Navitus Health Solutions LLC is a full service, URAC-accredited pharmacy benefit management company. It was founded in 2003, and is headquartered in Appleton, Wisconsin, USA, with a workforce of 1001-5000 employees. Its website is Company H1B Sponsorship Navitus Health Solutions has a track record of offering H1B sponsorships, with 1 in 2022. Please note that this does not guarantee sponsorship for this specific role.