Senior Specialist, Provider Services Support

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🔥 19 minutes ago

🐻 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

💵 $60.2k - $72.5k / year

⏰ Full Time

🟠 Senior

💝 Customer Support

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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

• Serve as the pharmacy network SME for all RFP, RFI, and proposal-related inquiries. • Develop, review, and maintain standardized pharmacy network response content within RFPIO/content libraries. • Ensure responses are accurate, consistent, and aligned with current network strategy, pricing models, and contractual terms. • Coordinate cross-functionally to gather inputs and deliver high-quality, client-ready responses. • Research, triage, and respond to pharmacy network service requests, including network structure and participation questions; pharmacy setup and configuration inquiries; claims, pricing, or access-related questions; and client and internal escalations. • Serve as a point of contact for network-related inquiries, ensuring clear communication and timely follow-up. • Partner with internal teams (e.g., Network Operations, Contracting, Analytics, Implementation) to investigate issues and drive resolution. • Track inquiries through to completion, ensuring accurate and complete resolution and proper documentation. • Identify recurring issues and escalate trends for process improvement or root cause resolution. • Identify and implement improvements to enhance RFP turnaround time, response quality, and service request resolution efficiency. • Track and report on KPIs, including RFP turnaround time, service request resolution time, response accuracy/rework rate, and knowledgebase utilization. • Contribute to cross-functional process improvements and standardization efforts. • Apply insights to strengthen both RFP responses and service solutions. • Other duties as assigned.

🎯 Requirements

• Bachelor’s degree in healthcare administration, business management, pharmacy, or related field, or equivalent work experience, required. • Pharmacy technician certification preferred. • 3+ years of business experience in PBM sales, proposals, client management, or project management required. • Strong understanding of PBM processes, pharmacy benefits, and healthcare industry regulations required. • 3 years of experience in business, finance or economics preferred. • 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!