WI3649166

1

Vocational Degree

Associate Degree

$51123 + yearly

Unspecified

40

JOB REQUIREMENTS: 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 EDI
(electronic data interchange) Claims Analyst 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
establishment and ongoing monitoring of EDI files received from external
partners for batch claim processing of subrogation and other payer
claims. The EDI Claims Analyst position also requires knowledge of both
the technical and operational sides of the business. Individuals in this
role will maintain a working knowledge of manual claim processing and
will partner with development resources to champion the enhancement of
current processing. This role will also work closely with Compliance,
Finance and Government Programs teams to meet subrogation regulatory
requirements. The EDI Claims Analyst will have direct authority to make
sound business decisions regarding client claims EDI data and will
demonstrate the ability to continually prioritize day to day workload to
meet individual, departmental and organizational goals for service and
performance. 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? Implements new EDI inbound claims files and
outbound eligibility data and maintains established EDI exchanges.
Monitors and resolves EDI claims batches to ensure accurate adjudication
of benefits in the claims processing system. Works directly with client
contacts, EDI vendors and Navitus\' Account Management team and
participates as EDI claims subject matter expert in all assigned new
client implementations and/or existing client change projects and
related meetings and communications. Analyses vendors\' custom, inbound
file layouts, interprets appropriate translation of data elements and
prepares data mapping specifications for IT development. Uses
self-directed, sound business judgment and expertise to identify, define
and formulate root cause analysis of EDI process\... For full info
follow application link. Navitus Health Solutions is an Equal
Opportunity Employer: Disabled/Veterans/Male/Female/Minority/Other
\*\*\*\*\* APPLICATION INSTRUCTIONS: Apply Online:
ipc.us/t/71B6128ECE5645B5