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Analyst, Accumulator

Navitus Health Solutions, LLC • UNAVAILABLE • Full-time

$55,190

per year

Process Improvement Data Management Pharmacy Benefits Health Plans Accumulator Analyst

Job Description

Company

Navitus

About Us

Navitus - 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._____________________________________________________________________________________________________________________________________________________________________________________________________________. Current associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities.

Pay Range

USD $26.51 - USD $31.95 /Hr.

Work Schedule Description (e.g. M-F 8am to 5pm)

M-F 8am to 4:30pm

Remote Work Notification

ATTENTION: Navitus is unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.

Overview

Due to growth, we are adding an Accumulator Analyst to our CAO Client department.

The Analyst, Accumulator 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 ongoing management of client accumulator processes and will function as the lead accumulator resource for assigned clients, as well as a back-up resource for peer coordinators when needed.

The Analyst, Accumulator requires knowledge of both the technical and operational sides of the business. This position will work closely with Information Technology, Benefit Configuration, Eligibility, and Client Services teams to understand the interdependences of each functional area. The Analyst, Accumulator will have direct authority to make sound business decisions regarding client accumulator data and will demonstrate the ability to continually prioritize day to day workload to meet individual, departmental, and organizational goals.

This position may include after-hour and/or weekend hours depending on workload.

Is this you? Find out more below!

Responsibilities

How do I make an impact on my team?

Oversees, manages and maintains accumulator data, processes and services for strategic and complex clients. This includes understanding client needs, plan designs, monitoring of electronic file loads and subsequent reports and any additional accumulator related processes.
Performs accumulator updates timely and accurately to prevent member access to care issues, missed performance guarantees and potential liquidated damages.
Works directly with client contacts and supports internal customers by participating in client meetings, audits and new program implementations with other areas of the company, answering accumulator questions and providing guidance to other areas and roles on accumulator processes.
Requests, validates and confirms full file data feeds from clients to ensure system integrity through audits and reconciliation.
Collaborates directly with client and/or Client Services team to report data file errors, accumulator reconciliation results and performance guarantee metrics on an agreed upon client schedule.
Leads process improvement, cost reduction and automation efforts. Independently assesses future business needs and brings recommendations to leadership.
Researches root cause of issues, troubleshoots viable resolutions and makes recommendations for corrective action.
Educates others on the accumulator process, providing talking points for Member Services to explain accumulator to members and pharmacies, to Client Services and Government Programs to explain corrective outcomes and to Sales Support for proposal responses.
Adapts to industry changes and evolving technology, maintaining an advanced to expert level of understanding of both legacy and emerging products and systems.
Conducts system enhancement and regression testing for highly complex accumulator related processes to ensure compliance with state, federal and client regulations/standards.
Contributes to training and maintains a mentoring relationship with new and existing accumulator team members. Assists in the creation and ongoing maintenance of departmental training materials, work instructions and policies.
Participate in, adhere to and support compliance and diversity, equity, and inclusion program objectives.
Other duties as assigned

Qualifications

What our team expects from you?

Education: Associate’s degree or equivalent work experience required.
Experience:
- Strong knowledge of Navitus systems and processes of the role with ability to perform tasks independently and follow instructions to make decisions required, typically with 2-3 years of experience.
- Experience with guiding and educating associates within current to lower-level roles.
- Experience with supporting mid-sized to large clients with moderate to high complexity.
- Experience with supporting health plan business with minimal guidance.
- Experience with the following tools at an intermediate to advanced level:
  - Navi-ClaimRx
  - Microsoft Office (Word, Excel, Dynamics (CRM))
  - Text Editing (e.g., Notepad++/UltraEdit)
  - Request Management (Service Desk, Connectus, Responsive)
  - Reporting (3D QlikView/QlikSense)
  - FTP File Transfer/Retrieval (FileZilla)