Job Description
Note: The job is a remote job and is open to candidates in USA. Navitus Health Solutions is a pharmacy benefit manager committed to making medications more affordable. They are seeking a Claims Quality Analyst responsible for validating claims accuracy and ensuring compliance with regulations. 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 Skills 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 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