Navitus Health Solutions

Business Intelligence Developer

• Create applications and data models for reporting needs using Qlikview, QlikSense, SQL Server Management Studio, Oracle SQL Developer, and other product tools
• Identify inter-departmental dependencies and downstream impacts of changes within reporting applications
• Extract, transform, and load data from various data sources
• Adapt to changing reporting requirements and new BI tools
• Conduct ongoing data validation to ensure data integrity and reliability
• Identify opportunities to streamline analytics processes and improve them
• Serve as analytics point of contact for state audits, legislative inquiries, and escalated analysis matters
• Lead and facilitate meetings with internal, external, and state stakeholders
• Mentor teammates and business areas as a Subject Matter Expert
• Perform other duties as assigned

Senior Developer, Business Intelligence

Benefits Coordinator

• Support day-to-day administration of employee benefits programs in compliance with plan documents and applicable regulations, including FMLA, ADA, COBRA, unemployment, and workers’ compensation requirements
• Administer associate benefit enrollment activities, including new hires, qualifying life events, executive enrollments, and open enrollment
• Ensure timely processing and accurate collection of required documentation
• Manage monthly benefits billing processes, including invoice reconciliation and approval for payment
• Monitor and maintain program trackers for benefit-related initiatives
• Oversee the benefits inbox by triaging incoming inquiries, assigning ownership, and responding to associate and leader questions
• Create, maintain, and deliver standard and ad hoc reports, including HR metrics and benefit enrollment reporting
• Review and approve associate changes submitted through Manager Self Service, including address, location, reporting relationships, job codes, job grades, and other non-pay-related fields
• Administer HRIS benefit eligibility file feeds, including setup, monitoring, and troubleshooting of system integrations and manual vendor files
• Support benefit communication planning and execution, including drafting associate communications and maintaining an annual benefits communication calendar
• Contribute to process improvement initiatives and partner with HR team members to implement improvements
• Support and uphold compliance, diversity, equity, and inclusion initiatives
• Perform other duties as assigned

Benefits Coordinator, HRIS

Analyst

• Complete scheduled and urgent configuration of new client implementations and/or network additions, terminations, and changes timely and accurately
• Acquire and maintain advanced knowledge of adjudication system screens and functions to design standard and custom configurations
• Ensure compliance with HIPAA, NCPDP, and Navitus internal business standards
• Perform quality assurance peer reviews of network plan additions and changes
• Research root causes, troubleshoot resolutions, and recommend corrective action
• Use workflow management, issue resolution, and reporting tools to troubleshoot complex customer questions and requests
• Support internal customers through client meetings, audits, and new program implementations
• Answer network setup questions and provide guidance on the network configuration process
• Maintain understanding of legacy and emerging products and systems
• Lead process improvement, cost reduction, and automation efforts
• Assess future business needs and provide recommendations to leadership
• Create and maintain training materials, work instructions, and policies
• Support client and sales presentations and respond to assigned RFP questions
• Perform other duties as assigned

Analyst III, Network Configuration

Client Services Representative

• Manage existing Pharmacy Benefit Management clients
• Co-develop long-term account strategy for assigned clients
• Identify upsell and expansion opportunities and incorporate them into annual strategic business plans
• Drive client retention, corporate strategic goals for the client base, and overall customer satisfaction
• Resolve customer issues related to contracts and reporting
• Interface with the Clinical Account Executive on clinical issues
• Delegate, support, and guide colleagues in Senior CSC and CSC roles
• Pull data from 3-D and other Navi-tools to deliver fact-based client presentations, including Strategic Business Plans, VALUE Summaries, and Performance Standard reports
• Coordinate with the Clinical Account Executive on data, strategy, and the Navitus team approach for meetings
• Develop plans to mediate unmet performance guarantees and conduct internal department debriefs
• Provide basic and specialized training on client-facing platforms
• Facilitate resolution of escalated member and client issues
• Manage client contract maintenance and performance
• Travel to client sites
• Mentor coordinator-level employees
• Perform other duties as assigned

Client Services Executive

Intake Specialist

• Place phone calls to new and existing Specialty Pharmacy patients
• Enroll patients into specialty services, including patient care management, copay assistance programs, and billing information
• Answer inbound calls from patients, prescribers, and other healthcare professionals
• Contact doctors to obtain necessary information
• Manage assigned workflow queues
• Accurately document information and set up prescription orders
• Translate prescription and patient information into pharmacy dispensing software
• Assist providers and insurance companies in triaging prior authorizations
• Assist other facility areas with pharmacy technician-type duties as needed
• Act in accordance with applicable federal and state laws and ethical standards
• Perform other duties as assigned

Intake Specialist I

Administration

• Ensure all environments are managed and maintained to meet service level agreements
• Administer and maintain Oracle Fusion applications and databases
• Implement security measures and access controls
• Support change control and testing processes for application system modifications
• Proactively monitor and maintain Linux and/or Windows system environments
• Provide responsive technical assistance and document configuration to support processes
• Work with functional teams to ensure optimal operations and uptime of application environments
• Analyze system performance and recommend improvements
• Develop strong working relationships with third-party vendors
• Research and recommend innovative and automated approaches for system administration tasks
• Resolve issues quickly and communicate proactively with stakeholders
• Recommend, schedule, and perform improvements, patches, and reconfigurations
• Develop, document, and maintain policies, procedures, and training plans for system administration
• Provide backup administration support to teammates
• Provide after-hours support
• Administer platforms including Microsoft SaaS, Atlassian SaaS, Oracle Fusion and ORMB, Dynamics D365, Nintex/K2, SmartConnect, Linux and Oracle technology stacks, Automic, Informatica, Qlik, Crystal, nPrint, privacy analytics, and data cataloging platforms

Administrator II, Atlassian Suites

Operations

• Manage the day-to-day operations of a team of pharmacy technicians
• Schedule and monitor staff and day-to-day workflow
• Monitor productivity, performance standards, prescription turnaround time, and service guarantees
• Plan and direct workflow and project assignments
• Develop employee skills, evaluate performance, and provide feedback
• Oversee resolution of employee relations issues
• Conduct hiring, training, and staff evaluation
• Monitor employee compliance with quality, service, production, attendance, and employment standards
• Assist Pharmacist in Charge and Pharmacist Managers with cost monitoring
• Work in production as needed
• Act as an escalation point for complex issues
• Represent pharmacy operations and service in cross-functional meetings and projects
• Assist with inventory drug file setup and maintenance
• Address shipping exceptions and patient notification
• Organize pharmacy supply deliveries and maintain adequate stock
• Develop policies, procedures, and the team business work plan
• Recognize and recommend operational improvements
• Perform other duties as assigned

Supervisor, Specialty Pharmacy Operations

Bilingual

• Place outbound phone calls to members to offer Medication Therapy Management (MTM) services and other commercial programs outside of traditional MTM
• Provide outreach to members, prescribers, and pharmacy providers to enhance care coordination and support the Star ratings program
• Field inbound phone calls from members to initiate MTM or other CEC services
• Conduct telephonic comprehensive medication interviews and document medications as part of the MTM Program
• Facilitate communication to clients, providers, and internal staff regarding CEC programs and program outcomes
• Maintain knowledge of regulations regarding CEC programs
• Develop a full understanding of Navitus Clients’ member experience and how the CEC contributes to improved health and wellness
• Comply with all applicable HIPAA and CMS regulations
• Perform other duties as assigned

Bilingual Spanish Pharmacy Technician, Telehealth

Customer Support

• Responsible for completing reports and projects as requested by Customer Care teams in a timely manner.
• Understand intermediate data relationship concepts and transform data into information that can be proactively used to improve business decisions.
• Create and maintain performance data for the whole of Customer Care.
• Deliver reports on a weekly, monthly, quarterly or annual basis as required by Customer Care Leadership.
• Perform quality assurance to ensure reports are accurate and in compliance with all regulations and requirements.
• Periodic and detailed reporting of call trends.
• Identify, advocate, and implement continual process improvement of policies and procedures to maximize quality and efficiencies.
• Assist with internal department and corporate projects as required.
• Coordinate task completion within department and cross-functionally.
• Solve moderately complex problems.
• Other duties as assigned.

Customer Care Reporting Specialist

Pharmacist

• Provide patient education through telephonic consultations for patients of the specialty pharmacy in accordance with Lumicera’s Patient Management Program.
• Answer clinical questions from patients and caregivers.
• Provide clear, detailed clinical documentation of patient consultations and interventions in pharmacy software in compliance with internal policies and procedures and external regulatory bodies (such as URAC) and EMR systems efficiently.
• Provide oversight of clinical outreach activities for specialty pharmacy patients.
• Interpret and clinically evaluate prescriptions for medications within all specialty disease states (including oncology) based on available information and resources.
• Follow through on complex orders. Contact providers and/or patients to verify information related to prescriptions such as drug strength, intended directions, and diagnosis to expedite processing of orders.
• Verify and confirm validity of controlled substances.
• Contact providers for new prescriptions, consult with physicians and nurses regarding clinical questions, and contact pharmacies for prescription transfers.
• Work with providers to convert prescriptions to generic, biosimilar, or preferred drugs whenever possible.
• Verify prescription information entered in the system by order entry. Answer clinical questions from the pharmacy team.
• Document and report medication errors in accordance with company policies and manufacturer contracts. Facilitate error reduction and prevention methods based off quality department and ISMP standards. Adhere to all Lumicera pharmacovigilance standards.
• Act in accordance with all applicable federal and state laws and with the highest ethical standards that we consistently strive to achieve. Willingness to obtain additional licensure based on business needs.
• Other duties as assigned

Pharmacist II – Clinical Consultation

AI Engineer

• Design, evolve, and own the enterprise AI governance framework, including use case intake workflows, risk classification standards, approval criteria, policy management, and responses to client RFP inquiries related to AI governance.
• Set the strategic direction for how governance scales with the organization’s growing AI footprint.
• Serve as the primary governance liaison to the Architecture Review Board, establishing review criteria for AI deployments and ensuring governance checkpoints are embedded in the release management lifecycle.
• Partner with Compliance to design and maintain the AI compliance monitoring approach, defining what gets monitored, how exceptions are surfaced, and how remediation is tracked.
• Proactively identify emerging risk patterns and recommend policy adjustments.
• Lead the organization’s response to evolving AI legislation and healthcare specific regulatory requirements by partnering with Legal, translating legal and regulatory developments into operational policies, stakeholder communications, and process updates that keep the organization ahead of compliance obligations.
• Own the enterprise AI use case inventory, including its structure, taxonomy, and lifecycle stages.
• Ensure every use case is accurately classified, tracked through approval, and documented with risk disposition and ownership.
• Define and continuously improve the AI risk assessment methodology, including scoring criteria, workflow design, and integration with the organization’s GRC platform (LogicGate).
• Collaborate with Vendor Management to establish the vendor AI evaluation framework, assessing model documentation for fairness, bias, transparency, and performance claims.
• Design and deliver the quarterly AI governance reporting package, including use case dashboards, risk trend analysis, and executive summaries.
• Present findings and recommendations to leadership, drive accountability for follow through on identified priorities, and use reporting insights to inform program strategy.
• Facilitate AI governance committee meetings and cross functional workgroups, setting agendas, framing decisions, facilitating productive discussion, and documenting outcomes.
• Manage escalation paths across governance tiers and represents the AI governance program in leadership forums and senior stakeholder meetings.
• Collaborate with Learning Services on the enterprise AI adoption and enablement strategy, including training roadmaps, engagement campaigns, usage analytics, and feedback loops.
• Drive measurable adoption outcomes and continuously refine the approach based on user behavior and organizational readiness.
• Collaborate and partner with engineering on proof of concept AI initiatives, including conversational agents and workflow automations, from problem framing through pilot evaluation.
• Other duties as assigned.

Lead, AI Governance – Enablement

• Responsible for operational aspects of Lumicera’s discount programs including contract compliance through direct pharmaceutical manufacturers
• Analyze claims data to ensure the accuracy of contract processing
• Provide sales and request for proposal (RFP) support for prospective clients and client renewals
• Work closely with the Lumicera Finance and Underwriting teams to assist with evaluating contracts
• Support contract review, data entry, evaluation, and reconciliation of Lumicera client contract financial guarantees
• Serve as direct contact for Lumicera Client Services attending client calls as needed
• Lead and coordinate Government-related or regulated reporting for internal use and client requirements
• Review Discount strategy and pharmaceutical manufacturer contracts to accurately set up and maintain parameters in the contract processing system

Analyst, Contract Operations

Account Manager

• Coach, mentor, and manage Account Management Trainers; set priorities and performance expectations aligned to business goals.
• Provide guidance and support to team members to ensure high performance and professional growth.
• Define onboarding and ongoing learning programs while actively contributing to curriculum design, content development, and training delivery.
• Ensure training materials, work instructions, and resource repositories are accurate, standardized, and maintained.
• Partner cross-functionally to align training with tools, workflows, and process changes while supporting adoption of key initiatives.
• Oversee coaching frameworks and provide direct support for complex development needs and performance gaps.
• Serve as the liaison between training and business teams to align priorities and share outcomes.
• Monitor training effectiveness and lead improvements to enhance consistency, efficiency, and impact.
• Other duties as assigned.

Supervisor, Account Management Training & Enablement

Customer Success Manager

• Analyze communication needs across Customer Success and develop structured approaches for delivering clear, consistent, and actionable messaging.
• Evaluate inputs from cross-functional partners to synthesize key updates, risks, and priorities into effective communications that support business objectives.
• Develop and manage recurring internal communication strategies, including establishing standards, formats, and governance practices.
• Partner with Marketing and Customer Success leadership to assess and prioritize communication requests, ensuring alignment with business priorities and outcomes.
• Own the development and evolution of Quarterly Business Review (QBR) materials, templates, and communication frameworks, recommending enhancements to improve clarity, consistency, and impact.
• Create and refine presentation materials for QBRs, finalist presentations, and client engagements, ensuring messaging aligns to strategic objectives and audience needs.
• Partner with the training team to support ongoing development of Customer Success team in QBR delivery, including enhancing executive presence, presentation effectiveness, and overall communication quality to drive more engaging and impactful client interactions.
• Assess effectiveness of communications and provide recommendations to improve engagement, understanding, and adoption across Customer Success teams.
• Support development of training and enablement content by identifying communication gaps and recommending improvements to messaging and delivery approaches.
• Other duties as assigned.

Customer Success Communications Specialist

Robotics

• Serve as a trusted advisor on finance operations, PBM workflows, and financial systems, providing guidance on process design, controls, and automation strategies.
• Drive cross-functional initiatives from intake through delivery, including managing structured request intake, prioritization, and workflow tracking to ensure alignment with business goals and governance standards.
• Assist finance with oversight of the end-to-end pharmacy payment operations, including 835 file generation, validation, reconciliation, and issue resolution; ensure accuracy, compliance, and effective controls across the payment lifecycle.
• Deliver advanced support for financial systems (e.g., ERP, billing, payment platforms), serve as an escalation point for complex issues, and support system enhancements, integrations, and releases.
• Design and implement automated workflows using tools such as Alteryx to streamline data processing, reconciliation, and reporting; monitor and govern automation to ensure reliability and data integrity.
• Conduct root cause analysis (e.g., 5 Whys) and redesign processes to reduce manual effort, eliminate defects, and prevent financial leakage while improving scalability and efficiency.
• Develop and govern SOPs, work instructions, and job aids to ensure standardized, audit-ready processes; support training and knowledge transfer across the organization.