Analyst, Claims Extract

November 13

🥔 Idaho – Remote

Although this job is listed in Idaho, this company may be open to hiring remote in other states.

💵 $22 - $27 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

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Navitus Health Solutions

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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.

1001 - 5000 employees

Founded 2003

⚕️ Healthcare Insurance

💊 Pharmaceuticals

🤝 B2B

📋 Description

• Oversees, manages and maintains claims extract data processes and services for clients of low to moderate complexity. • This includes understanding client needs, plan designs, standard and custom data file layouts, monitoring of electronic file deliveries and subsequent reports. • Interprets client specific rules, translates data elements, provides technical mapping specifications to IT programmers and fully tests all changes to ensure quality and accuracy of extract files. • Functions as both a business and technical liaison between requesting business areas and Data Services programming resources. • Participates in existing client changes of low to moderate complexity, acting as the subject matter expert for claims extracts in all related meetings and communications. • Collaborates directly with client and/or Client Services team to report data file delivery issues on an agreed upon client schedule. • Gains a working knowledge of claims processing in order to review processed claims and reversals, plan design, drug tiers and issues clients encounter loading Rx claims into their systems. • Uses sound business judgment and reporting expertise to contribute toward the creation of root cause analysis of issues. • Independently assesses business needs and participates in process improvement, cost reduction and automation efforts. • Educates others on the claims extract process, providing talking points to Client Services and Government Programs for client and plan sponsor discussions. • Adapts to industry changes and evolving technology, maintaining a basic to intermediate level of understanding of both legacy and emerging products and systems. • Assists in the creation and ongoing maintenance of departmental training materials, work instructions and policies. • Conducts system enhancement and regression testing for low to moderately complex claims extract related processes to ensure compliance with state, federal and client regulations/ standards. • Other duties as assigned.

🎯 Requirements

• Associate’s degree or equivalent work experience required. • Minimal experience and/or training to begin learning skills, systems, and processes of the role with ability to perform tasks with close supervision. • Experience on basics and gaining familiarity with the role and company. • Basic experience with Microsoft Office, specifically Word and Excel. • 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!