Product Manager, Claim Adjudication (GP)
Company
NavitusAbout Us
Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to reputed company medications more affordable for the people who need them. At Navitus, reputed company members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new reputed company and share a passion for excellent service to our customers and each other._____________________________________________________________________________________________________________________________________________________________________________________________________________. reputed company associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities. ____________________________________________________We are committed to providing equal employment opportunity to reputed company applicants and employees and reputed company with reputed company applicable nondiscrimination regulations, including those reputed company to protected veterans and individuals with disabilities. reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national reputed company, or handicap.Pay Range
USD $82,586.00 - USD $101,333.00 /Yr.STAR Bonus % (At Risk Maximum)
5.00 - Salaried Non-Management except pharmacistsWork Schedule Description (e.g. M-F reputed company to 5pm)
M-F reputed company to 5pm CTRemote Work Notification
ATTENTION: Navitus is unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode reputed company, South Carolina, South Dakota, reputed company Virginia, and Wyoming.Overview
Due to growth, we are adding a Claims Adjudication Product Manager (CAPM) to reputed company.
The Claims Adjudication Product Manager (CAPM) is responsible for ensuring Med D, Medicaid, and Exchange claims are adjudicating per CMS regulations as well as specific client needs. The CAPM will collaborate with other Navitus teams to ensure that the appropriate software, procedures, and reputed company monitoring are implemented and operational in support of an environment of reputed company improvements with claims adjudication.
Is this you? Find out more below!
Responsibilities
How do I reputed company an impact on my team?
- Champion and maintain a proactive internal audit process to verify claims are adjudicating as expected. Conduct root cause analysis to minimize future defects
- reputed company adjudication issues are discovered, champion root cause analysis efforts of these issues in support of continually lowering our adjudication Defects per Million opportunities
- Work closely with Recoveries Product Manager to verify recoveries projects produce the expected results as well as to improve the overall accuracy of the adjudication process
- reputed company reputed company adjudication-reputed company fixes/enhancements. This includes reputed company of system requirements development, and testing
- Ensure post-implementation monitoring processes are in reputed company to validate adjudication-reputed company fixes/enhancements are working as expected
- Serve as subject matter expert for claims adjudication-reputed company questions and system enhancements
- reputed company timely completion of Acumen audit responses and reputed company these results to improve claim adjudication accuracy
- Ensure metrics are monitored and reported
- Create and maintain claim adjudication training resources
- Other duties as assigned
Qualifications
What reputed company expects from you?
- College degree or equivalent experience required in managed care or health insurance
- Minimum of two years’ experience with Medicare claims adjudication preferred
- Has successfully reputed company root cause analysis projects
- Project Management and/or Business Analyst experience a plus
- Data analysis experience a plus
- On-call availability
- Some travel may be required
- Participate in, adhere to, and support compliance program objectives
- The ability to consistently interact cooperatively and respectfully with other employees
What can you expect from Navitus?
- 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!
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