Product Manager, Claim Adjudication
Navitus Health Solutions
full-time
Posted on:
Location Type: Remote
Location: Idaho • United States
Visit company websiteExplore more
Salary
💰 $82,586 - $101,333 per year
About the role
- Champion and maintain a proactive internal audit process to verify claims are adjudicating as expected.
- Conduct root cause analysis to minimize future defects
- When adjudication issues are discovered, champion root cause analysis efforts of these issues in support of continually lowering our adjudication Defects per Million opportunities
- Work closely with Recoveries Product Manager to verify recoveries projects produce the expected results as well as to improve the overall accuracy of the adjudication process
- Oversee all adjudication-related fixes/enhancements. This includes oversight of system requirements development, and testing
- Ensure post-implementation monitoring processes are in place to validate adjudication-related fixes/enhancements are working as expected
- Serve as subject matter expert for claims adjudication-related questions and system enhancements
- Oversee timely completion of Acumen audit responses and leverage these results to improve claim adjudication accuracy
- Ensure metrics are monitored and reported
- Create and maintain claim adjudication training resources
- Other duties as assigned
Requirements
- College degree or equivalent experience required in managed care or health insurance
- Minimum of two years’ experience with Medicare claims adjudication preferred
- Has successfully lead root cause analysis projects
- Project Management and/or Business Analyst experience a plus
- Data analysis experience a plus
- On-call availability
- Some travel may be required
- Participate in, adhere to, and support compliance program objectives
- The ability to consistently interact cooperatively and respectfully with other employees
Benefits
- 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!
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
claims adjudicationroot cause analysisdata analysisproject managementbusiness analysissystem requirements developmentpost-implementation monitoringmetrics reportingaudit process
Soft Skills
cooperative interactionrespectful communicationleadershipproblem-solving
Certifications
college degreemanaged care experiencehealth insurance experience