Navitus Health Solutions · 2 months ago
Analyst, Claims Extract
United States
Full-time
Remote
New Grad, Entry Level
$22.74/hr - $27.08/hrNavitus Health Solutions is seeking an Analyst, Claims Extract to join our team! This role is responsible for managing client claims extract processes and ensuring alignment with the Claim Adjudication Operations team to meet the business needs of our customers and clients.
Health CareInformation Technology
Responsibilities
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
Qualification
Required
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!
Company
Navitus Health Solutions
Navitus Health Solutions LLC is a full service, URAC-accredited pharmacy benefit management company.
Founded in 2003
1001-5000 employees
H1B Sponsorship
Navitus Health Solutions has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2022 (1)
Funding
Current Stage
Late StageLeadership Team
George Hepburn
SVP and Chief Financial Officer
Peter Beste
CFO
Recent News
Company data provided by crunchbase