Coordinator, Manual Claims

The Coordinator, Manual Claims 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 position is responsible for processing of pharmacy and/or direct member reimbursement (DMR) claims of all levels of complexity to execute the claims adjudication process including correction of claims. The Coordinator, Manual Claims will manage the day-to-day processes and changes made to a client’s benefit or a pharmacy’s contract. This role requires knowledge of both the technical and operational sides of the business. The Coordinator, Manual Claims will have direct authority to make sound business decisions with regard to processing of a claim. Accurately processes claims within the claims adjudication system within specified client performance guarantee timeframes, guarding client and Navitus from potentially high dollar financial liabilities. Acquires and maintains a basic understanding of Navitus’ claims adjudication system, plan designs and upstream/downstream processes. Interprets client specific rules to ensure quality and accuracy of processing.