Note: The job is a remote job and is open to candidates in USA. Navitus Health Solutions is a healthcare and pharmacy benefit management organization. The Sr. Systems Analyst, Claim Adjudication supports, tests, and triages claim adjudication system issues and enhancements while providing expertise on system capabilities, risks, configuration, and global impacts. The role also collaborates with business and IT teams, supports compliance and industry standards, and mentors less experienced team members.
Responsibilities
- Maintain strong working relationships with members of the business and IT
- Maintain in-depth detailed knowledge of the claim adjudication system capabilities and limitations
- Provide subject matter expertise, participate in the design of innovative solutions to improve system configuration, claim processing, accuracy and efficiency of claims processing, and support large effort initiatives within the claims adjudication space
- Identify risk, deliver quantified fact-based supporting details and provide a recommendation and detailed plan for mitigation
- Mentoring of less experienced team members
- Peer review to evaluate performance of team members as requested
- Ensure accurate security configuration within the claims adjudication platform to minimize unauthorized access
- Collaborate with functional areas and share new system capabilities
- Review and understand NCPDP workgroup outcomes, participate in appropriate NCPDP task groups, share industry best practices and standards
- Other duties as assigned
Skills
- A two-year college or university degree and/or a minimum of five years of work experience is required
- Professional PBM industry work experience is required
- Healthcare industry practices and HIPAA knowledge
- Experience as a member of a multi-disciplinary team
- The ability to consistently interact cooperatively and respectfully with other employees
- Knowledge of applicable data privacy practices and laws is preferred
- Understanding of Agile methodology a plus
Benefits
- Top of the industry benefits for Health, Dental, and Vision insurance
- 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!
- Remote work for residents of Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Jersey, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Tennessee, Texas, Utah, Vermont, Virginia, Washington, Washington DC, and Wisconsin
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