Navitus Health Solutions · 3 days ago

Analyst, Claims

United States

Full-time

Remote

Mid Level

$50K/yr - $59K/yr

4+ years exp

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Responsibilities

Collaborates with benefit configuration analysts and internal customers using sound business judgement and expertise to research and determine root causes for claim processing issues of low to moderate complexity

Works simultaneously on multiple claim processing issues using subject matter expertise to enhance and improve the accuracy of claim processing

Acquires and maintains an intermediate to advanced level of knowledge and interpretation of benefit designs and adjudication system screens and functions

Applies advanced reporting and data analysis techniques to identify error types, root causes and quantity of claims affected

Establishes and utilizes standard templates to document and share a comprehensive summary of findings including a systemic impact analysis with CAO leadership and all relevant functional areas

Recommends retraining, new training and/or corrective action plans based on findings and works closely with benefit configuration trainers and coaches to take appropriate action to mitigate future occurrences and financial risk to client and/or Navitus

Adapts to industry changes and evolving technology, maintaining an intermediate to advanced level of understanding of both legacy and emerging products and systems

Uses departmental workflow management, issue resolution and reporting tools for troubleshooting and responding to moderate to complex customer requests

Independently assesses business needs and participates in process improvement, cost reduction and automation efforts

Other duties as assigned

Qualification

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NaviClaimRxClaims ProcessingData AnalysisMicrosoft OfficeFormulary ManagementRequest ManagementReporting ToolsProcess ImprovementSoft Skills

Required

Bachelor’s degree or equivalent work experience

Participate in, adhere to, and support compliance program objectives

The ability to consistently interact cooperatively and respectfully with other employees

Preferred

Minimum of four (4) years of experience in NaviClaimRx or other table-based claims processing systems preferred

Experience with the following tools at an intermediate to advanced level preferred: Claims Processing, Microsoft Office (Word, Excel, PowerPoint), Formulary Management, Request Management (Connectus, Service Desk), and Reporting (3D QlikView/QlikSense)