Navitus Health Solutions ยท 2 days ago
Claims Quality Analyst
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Health CareInformation Technology
Insider Connection @Navitus Health Solutions
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
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Required
Bachelor/Associate Degree in business related field; or equivalent combined education and experience preferred.
1 - 3 years related work experience preferably in pharmaceutical claims adjudication systems, retail pharmacy, or in a health plan organization
Participate in, adhere to, and support compliance program objectives
The ability to consistently interact cooperatively and respectfully with other employees
Benefits
Health Insurance
Dental Insurance
Vision Insurance
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 โ up to $750!
Company
Navitus Health Solutions
Navitus Health Solutions LLC is a full service, URAC-accredited pharmacy benefit management company.
Funding
Current Stage
Late StageRecent News
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