Navitus

We are adding a Coordinator, Operations Data to our CAO Implementation department. The person in this role ensures efforts are in alignment with the Claim Adjudication Operations (CAO) team to leverage technology and process improvement for the purpose of meeting the business needs of Navitus customers, clients, members, and pharmacies by accurately administering benefits. The successful candidate will be responsible for capturing and managing data from Kanban boards, ensuring data accuracy, generating operational reports, assisting with the sizing of operational requests, and supporting various process improvement initiatives.

The Supervisor, Claim Adjudication Operations ensures the streamlined operation of the Claim Adjudication Operations team in alignment with customer-focused objectives. This individual will plan, design, coordinate and align resources to support the daily activities of the team. The supervisor will work closely with their team to identify, recommend, develop, implement, support, and improve customer-focused solutions.

The Pharmacist I, Clinical Prior Authorization will be responsible for performing Prior Authorizations, Drug Utilization Review, and supporting Customer Care with clinical calls requiring pharmacist intervention. They will interface with physicians, pharmacists, and specialty pharmacy providers regarding beneficiaries’ benefits and therapeutic interventions and review health surveys and utilization data for program management and development.

This role ensures efforts are in alignment with the Claim Adjudication Operations (CAO) team to leverage technology and process improvement for the purpose of meeting the business needs of Navitus customers, clients, members, and pharmacies by accurately administering benefits. This role is responsible for the ongoing management of client accumulator processes and will function as the lead accumulator resource for assigned clients, as well as a back-up resource for peer coordinators when needed.

The Analyst, Tech. Operations Government Programs has responsibility for executing Government Programs processes accurately, efficiently, and in compliance with CMS regulations. Assignments may include EGWP enrollment administration and oversight, Retro-eligibility processes, Financial Information Reporting, and more. They will also oversee schedules for assigned processes and ensure documentation accurately reflects the current process.

This position ensures efforts are in alignment with the Claim Adjudication Operations (CAO) team to leverage technology and process improvement for the purpose of meeting the business needs of Navitus customers by accurately administering benefits. The Benefit Configuration Analyst configures benefits in the claim adjudication system based on specifications from internal customers and external clients.

The Account Management Trainer is a highly motivated professional with at least 2 years of successful experience in training or adult learning. The Trainer is responsible for developing learning content, creating departmental training programs, drafting training schedules, and executing tactical and operational tasks to meet the training needs of Account Management team members.

Responsible for the development, administration, maintenance, and oversight of the COB Program, ensuring that the appropriate software, processes, procedures, and oversight monitoring are implemented and operational to meet changing COB program needs.

The Engineer, Data Integration ensures efforts are in alignment with the Enterprise Architecture team to support customer-focused objectives. The Engineer, Data Integration will help define and grow our data centric architecture and is responsible for implementing data ingestion, validation, and transformation pipelines. The Engineer, Data Integration will design and maintain batch and streaming integrations across a variety of data domains and platforms.