Coordinator, Manual Claims

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 $18.67 - USD $21.96 /Hr.

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

M-F 8am to 5pm

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

Navitus Health Solutions is seeking a Manual Claims Coordinator to join our team!

 

The Coordinator, Manual Claims 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 position is responsible for processing of pharmacy and/or direct member reimbursement (DMR) claims of all levels of complexity to execute the claims adjudication process including correction of claims.

 

The Coordinator, Manual Claims will manage the day-to-day processes and changes made to a client’s benefit or a pharmacy’s contract. This role requires knowledge of both the technical and operational sides of the business. The Coordinator, Manual Claims will have direct authority to make sound business decisions with regard to processing of a claim. The Coordinator, Manual Claims will collaborate closely with Member Services, Clinical Services, Client Services, Benefit Configuration, and Government Programs to understand the interdependences of each team pertaining to processing of manual claims.

 

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? 

• Accurately processes claims within the claims adjudication system within specified client performance guarantee timeframes, guarding client and Navitus from potentially high dollar financial liabilities.
• Acquires and maintains a basic understanding of Navitus’ claims adjudication system, plan designs and upstream/downstream processes. Interprets client specific rules to ensure quality and accuracy of processing.
• Manages intake, scanning and categorization of inbound mail. Processes and mails outbound letters to members and pharmacies.
• Creates, validates and confirms large batches of claims prior to electronic processing.
• Learns and abides by HIPAA and other regulatory requirements to participate in client, compliance, and state/federal audits. Includes compilation of claim files, audit universes, report creation and analysis, validation of claims against benefit allowances and responding to auditor questions verbally and in writing.
• Participates in new client implementations and supports existing clients of low to moderate complexity, acting as the representative for manual claims in all related meetings and communications.
• Assesses business needs and participates in process improvement, cost reduction and automation efforts.
• Uses sound business judgment and expertise to contribute toward the creation of root cause analysis of issues.
• Assists in the creation and ongoing maintenance of departmental training materials, work instructions and policies.
• Communicates the nature of processing claims with all departments, providing talking points for Member Services to explain claim processing reimbursements to members and pharmacies, and Client Services or Government Programs to explain claim correction outcomes.
• Adapts to industry changes and evolving technology, maintaining a basic to intermediate level of understanding of both legacy and emerging products and systems and conducts any relevant system enhancement and regression testing.
• 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:
  • Minimal experience and/or training to begin learning skills, systems, and processes of the role with ability to perform tasks with close supervision.
  • Basic experience with Microsoft Office, specifically Word and Excel.

What can you expect from Navitus?      • 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  #LI-Remote

 

Location : Address

Remote

Location : Country

US