Analyst, Claims QualityNavitus Health Solutions / Lumicera Health Services • New York, New York, United States
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Analyst, Claims Quality
Navitus Health Solutions / Lumicera Health Services
- New York, New York, United States
- New York, New York, United States
Über
Navitus is growing, and we are adding a Claims Quality Analyst to our team. The Claims Quality Analyst is responsible for validating that Med D, Medicaid, and Exchange claims adjudicate per State/CMS regulations as well as specific client needs. Responsibilities
Audit claim data for Medicare Part D, Medicaid, and Exchange lines of business to validate their accuracy. Assist with post-implementation monitoring to validate adjudication-related fixes/enhancements are working as expected. Assist with Claims Adjudication testing by running test claims. Work in partnership with the Technical Operations Business Analysts and Product Managers to manage changes to existing processes, including defining requirements, creating/executing test plans, and post-implementation oversight. Complete tasks associated with the assigned processes, performing appropriate oversight, coordinating the resolution of issues with both internal and external stakeholders, using independent judgement to determine the best resolution. As needed, may require working outside of normal business hours to complete time-sensitive processes. Other duties as assigned. Qualifications
Bachelor/Associate Degree in a business-related field; or equivalent combined education and experience preferred. 1 - 3 years related work experience preferably in pharmaceutical claims adjudication systems, retail pharmacy, or in a health plan organization. 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! Pay Range
USD $42,505.00 - USD $50,601.00 /Yr Work Schedule Description
M-F 8am to 5pm CT Remote Work Notice
Navitus is unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming. Location
Remote Location : Country
US
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Sprachkenntnisse
- English
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