Analyst III, Network Configuration

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Navitus Health Solutions

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2003

💼 Consulting

🛡️ Insurance

🏥 Healthcare

Consulting • Insurance • Healthcare

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

• Complete scheduled and urgent configuration of new client implementations and/or network additions, terminations, and changes timely and accurately • Acquire and maintain advanced knowledge of adjudication system screens and functions to design standard and custom configurations • Ensure compliance with HIPAA, NCPDP, and Navitus internal business standards • Perform quality assurance peer reviews of network plan additions and changes • Research root causes, troubleshoot resolutions, and recommend corrective action • Use workflow management, issue resolution, and reporting tools to troubleshoot complex customer questions and requests • Support internal customers through client meetings, audits, and new program implementations • Answer network setup questions and provide guidance on the network configuration process • Maintain understanding of legacy and emerging products and systems • Lead process improvement, cost reduction, and automation efforts • Assess future business needs and provide recommendations to leadership • Create and maintain training materials, work instructions, and policies • Support client and sales presentations and respond to assigned RFP questions • Perform other duties as assigned

🎯 Requirements

• Associate’s degree or equivalent work experience required • Typically 2-3 years of experience with strong knowledge of Navitus systems and processes • Ability to perform tasks independently, follow instructions, and make decisions • Experience guiding and educating associates in current to lower-level roles • Experience supporting mid-sized to large clients with moderate to high complexity • Experience supporting health plan business with minimal guidance • Intermediate to advanced experience with Navi-ClaimRx • Intermediate to advanced proficiency with Microsoft Office (Word, Excel, PowerPoint) • Experience with Formulary Management • Experience with Request Management tools (Connectus, Service Desk, Responsive) • Experience with Government Programs Error Management (GEMS) • Experience with Reporting tools (3D QlikView/QlikSense) • Participate in, adhere to, and support compliance program objectives • 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! • STAR Bonus % (At Risk Maximum) 5.00