Navitus Health Solutions · 2 days ago

Claims Quality Analyst

United States

Full-time

Remote

Entry, Mid Level

$43K/yr - $51K/yr

1+ years exp

Wonder how qualified you are to the job?

Maximize your interview chances

Health CareInformation Technology

Insider Connection @Navitus Health Solutions

Discover valuable connections within the company who might provide insights and potential referrals, giving your job application an inside edge.

Responsibilities

Audit claim data for Medicare Part D, Medicaid, and Exchange lines of business to validate their accuracy.

Assist with post-implementation monitoring to validate adjudication-related fixes/enhancements are working as expected.

Assist with Claims Adjudication testing by running test claims.

Work in partnership with the Technical Operations Business Analysts and Product Managers to manage changes to existing processes, including defining requirements, creating/executing test plans, and post-implementation oversight.

Complete tasks associated with the assigned processes, performing appropriate oversight, coordinating the resolution of issues with both internal and external stakeholders, using independent judgement to determine the best resolution

As needed, may require working outside of normal business hours to complete time sensitive processes

Other duties as assigned

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Pharmaceutical Claims Adjudication SystemsRetail PharmacyHealth Plan OrganizationCompliance Program AdherenceProblem-SolvingInterpersonal Communication