Implementation Analyst jobs in Appleton, WI

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.

We are 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.

The Analyst, Claims Extract 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.

This role is responsible for the ongoing management of client claims extract processes and will function as the lead resource for assigned clients, as well as a back-up resource for peer analysts when needed.

This position requires knowledge of both the technical and operational sides of the business. The Analyst, Claims Extract will work closely with Information Technology, Benefit Configuration, Accumulators, Eligibility and Client Services teams to understand the interdependences of each functional area.

Individuals in this role will have direct authority to make sound business decisions regarding client claims data and will demonstrate the ability to continually prioritize day to day workload to meet individual, departmental and organizational goals.

This position may include after-hour and / or weekend hours depending on workload.

Is this you? Find out more below!

How do I make an impact on my team?

• 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, cost 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.

• Associate degree or equivalent work experience
• Basic experience with Microsoft Office, specifically Excel and Word
• 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?

• Hours / Location : Monday-Friday 8 : 00am-5 : 00pm, CST-Remote
• Paid Volunteer Hours
• Educational Assistance Plan and Professional Membership assistance
• Referral Bonus Program up to $750!
• Top of the industry benefits for Health, Dental, and Vision insurance, Flexible Spending Account, Paid Time Off, Nine paid holidays, 401K, Short-term and Long-term disability, College Savings Plan, Paid Parental Leave, Adoption Assistance Program, and Employee Assistance Program

LI-Remote

Last updated : 2024-05-09