Claims Quality Analyst
Navitus Health Solutions
full-time
Posted on:
Location Type: Remote
Location: Idaho • United States
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Salary
💰 $42,505 - $50,601 per year
Job Level
About the role
- 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
Requirements
- Bachelor/Associate Degree in 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
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
audit claim dataclaims adjudication testingtest claimspost-implementation monitoringdefining requirementscreating test plansexecuting test plansoversightissue resolution
Soft Skills
independent judgementcooperative interactionrespectful communication