Supervisor, Claim Adjudication Operations

🕒 June 11

🐻 Alaska, Hawaii, +11 more states – Remote

🐻 Alaska – Remote 🌺 Hawaii – Remote 🦞 Maine – Remote 🗻 New Hampshire – Remote 🌶️ New Mexico – Remote 🌾 North Dakota – Remote 🎸 Mississippi – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote 🦬 Wyoming – Remote

💵 $63.9k - $76.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

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Navitus Health Solutions

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2003

⚕️ Healthcare Insurance

💊 Pharmaceuticals

🤝 B2B

Healthcare Insurance • Pharmaceuticals • B2B

Navitus Health Solutions is a pharmacy benefit manager (PBM) that provides transparent, people-centered pharmacy benefit solutions to health plans, employers, government programs and other plan sponsors. The company operates a 100% pass-through, cost-plus model that emphasizes lowering medication costs, managing formularies, specialty drug management (including a cost-plus specialty pharmacy), claims adjudication, pharmacy network management, and member enablement and support services. Navitus positions itself as a fiduciary partner focused on affordability, compliance, clinical quality and improving health outcomes through tailored PBM services and digital health integrations.

📋 Description

• Oversee roles within the Claim Adjudication Operations department to support accurate and timely configuration and data transfers of client hierarchy, benefits, and networks. • Provide superior customer service utilizing a high-touch, customer centric approach focused on collaboration and communication. • Outreach and collaborate with CAO customers/partners for day-to-day work and contribute to action plan creation. • Oversight of work on Kanban boards, meeting turnaround times and performance guarantees. • Run department Kanban board(s) and huddles, including sizing of work requests. • Resource assignment of day-to-day work, audits, and root cause analysis/CAP. • Perform 1:1s to elicit feedback from department associates, provide mentorship, discuss career development, address performance, and provide workload and project guidance. • Perform workforce management duties for direct reports, including, but not limited to, overtime needs, time out of the office and time tracking. • Apply soft skills toward team members and external stakeholders alike in understanding every point of view and coming to the table with good negotiation skills. • Must have the ability to work with different personalities across all departments and understand their point of view to communicate accordingly. • Adhere to department level objectives to ensure alignment with division and company strategic initiatives. • Participate in, adhere to and support compliance and diversity, equity, and inclusion program objectives. • Other duties as assigned.

🎯 Requirements

• Bachelor’s degree or equivalent work experience is required. • 4 years of experience required. • Knowledge of one or more responsibilities as defined above is strongly preferred. • Professional PBM industry work experience is preferred. • Knowledge of applicable data privacy practices and laws is preferred. • Healthcare industry practices and HIPAA knowledge would be a plus. • Experience as a member of a multi-disciplinary team is a plus. • Understanding of human resource management principles, practices, and procedures would be a plus.

🏖️ 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!