US Claro

Pharmacist

• Make decisions regarding the resolution of pharmacy issues
• Establish and maintain contracts with pharmacy providers
• Facilitate submittal, receipt, tracking, and process flow of contracts between Navitus and providers
• Accurately enter information and maintain contract database
• Generate reports on network performance to monitor the claims accuracy throughout the terms of the contract
• Responsible for creating networks based on the contract terms within the claims processing system and ensure accuracy with performing quality reviews
• Assist in resolving intricate pharmacy provider issues and complaints
• Coordinate pharmacy network communication efforts including collection of content, disseminating information to provider partners through appropriate channels, and tracking response metrics
• Other duties as assigned

Pharmacy Relations Specialist

• Perform telephonic consultations with patients regarding the use of their specialty medication and management of their disease state.
• Perform medication reconciliation, screen for potential drug interactions, and provide side effect management recommendations.
• Interpret physicians' prescriptions and contact prescribers for prescription clarification.
• Expedite the processing of orders and verify prescription information.
• Provide patient education through telephonic consultations in accordance with Lumicera’s Patient Management Program.
• Adapt to new workflows and processes, solve unique pharmaceutical problems, and stay current with advancements in specialty pharmacy therapies.
• Back up other pharmacists as needed and document medication errors per company policies and procedures.

Pharmacist, Clinical Consultation

QA Engineer

• Test assigned stories for acceptance criteria and regression testing while utilizing a continuous “test to break it” approach
• Participate in Sprint ceremonies based upon assigned initiatives
• Participate in QA Community of Practice
• Consider automation and work with sister teams to help implement, test and communicate updated scripts
• Perform overall risk analysis for assigned testing stories
• Escalate barriers to completion to Manager
• Creation of dashboard and documentation necessary as required by the testing scope of requested initiatives
• Manage internal and external customer expectations and other Navitus stakeholder expectations
• Assume accountability for providing & improving quality testing metrics associated with projects, portfolios and IT departments
• Other duties as assigned

Quality Assurance Tester

• Provide patient education through telephonic consultations for patients of the specialty pharmacy in accordance with Lumicera’s Patient Management Program.
• 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. Including but not limited to, pharmacy transfers, prescription clarifications, and incomplete patient consultations.
• Interpret and clinically evaluate prescriptions for medications within all specialty disease states (including oncology) based on available information and resources.
• 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 prescription information entered in the system by order entry. Answer clinical questions from the pharmacy team. Provide inter- and intra-departmental feedback and coaching on appropriate prescription entry and documentation as necessary.
• 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.
• Other duties as assigned

Pharmacist II, Clinical Consultation

Systems Engineer

• Maintain detailed knowledge of the claim adjudication system capabilities and limitations
• Provide subject matter expertise, participate in the design of innovative solutions to improve system configuration, claim processing, and the accuracy and efficiency of claims processing
• Support large effort initiatives within the claims adjudication space
• Identify risk, deliver quantified fact-based supporting details and provide a recommendation and detailed plan for mitigation
• Mentoring of less experienced team members
• Ensure accurate security configuration within the claims adjudication platform to minimize unauthorized access
• Review and understand NCPDP workgroup outcomes, participate in appropriate NCPDP task groups, share industry best practices and standards
• Other duties as assigned

Systems Analyst II, Claim Adjudication

Full-stack Engineer

• Research and identify technology upgrades which will enhance the ability to deliver robust solutions
• Ensure the new projects and enhancements to legacy solutions (where possible) work towards an enterprise architecture as opposed to a proliferation of point solutions
• Work with other technical teams to define and identify cross-functional solutions for integration with new or existing technologies
• Lead application and system architecture design working in conjunction with partners in the areas of architecture and infrastructure
• Lead the effort for design, development and implementation to deliver solutions which are easily maintainable and scalable
• Direct or indirect involvement in the development of policies, standards, and guidelines that direct the selection, development, implementation and use of Information Technology within the enterprise
• Provide coaching and guidance to colleagues to ensure applications, services, and processes are developed in a way that complies with architectural guidelines and established methodologies
• Informs management and provides recommendations for mitigation of potential bottlenecks or single-points of failure within the environment that may affect system performance or availability
• Estimate effort required for the design, development and implementation of technical solutions
• Other duties as assigned

Senior Software Engineer

Client Services Representative

• Support/back up the CSE, Senior CSC and CSC responsibilities
• Create and present data for Strategic Business Plans, VALUE Summaries, and Performance Standard reports
• Investigate/follow-up if Performance Guarantees are not met and present those results to their assigned clients
• Conduct Client training (Client Portal Site, Navi-Claim, etc.)
• Assist with escalated member/Client issues requests
• Identify and present Client opportunities to improve costs, service and health
• Contract maintenance and performance
• Lead or support internal department and corporate projects
• Travel to Client sites
• Provide mentoring to the coordinator levels and CSEs
• Other duties as assigned

Senior Client Services Executive

Content Writer

• Support Navitus' client acquisition and retention efforts by drafting responses to Requests for Proposals (RFPs) and other sales-related documents for a variety of client audiences.
• Sales support activities can include project coordination (e.g., planning, scheduling, organizing, and coordination), follow-up correspondence, and reporting
• Utilize expert-level editorial, grammatical, and writing skills to ensure all written deliverables follow and demonstrate tactical, strategic, financial, and sales-capture decisions
• Proficiently understand and continuously develop knowledge of business units target markets and trends in those markets and how the products and services are/or may be utilized in the target markets
• Utilize strong project management skills to initiate, collect and deliver on analytical tasks in collaboration with cross-functional SMEs
• Demonstrate an attention to detail and strong time management skills by developing and adhering to stringent timelines
• Support proposal content management and department processes to keep materials current and competitive
• Contribute to the department goal of improved efficiency and effectiveness, including identifying and providing insights into streamlining departmental processes
• Other duties as assigned

Proposal Writer

Operations

• Assignments may include one or more of the following: Employer Group Waiver Plan (EGWP) enrollment administration and oversight, Retro-eligibility processes, Financial Information Reporting (FIR), Plan Finder Submission, Coordination of Benefits (COB), Reject Management, Prescription Drug Event (PDE) error management and reconciliation, Medicaid Encounter Data, Affordable Care Act (ACA) Claims Submission, Explanation of Benefits (EOB), Retiree Drug Subsidy (RDS), and Claim Auditing
• Oversee the schedules for the processes assigned, adjust schedules when necessary to ensure deadlines are met, and alert management when schedules are at risk
• Ensure process documentation accurately reflects the current process and update when necessary
• Assist subject matter experts (SME) in defining and documenting process steps, providing input on requirements for technical specifications
• Review and research errors and prioritize reconciliation efforts in accordance with State and Federal guidance
• Effectively communicate with Employer Groups, Clients, State/Federal Agencies, external vendors and Navitus internal departments to address action items, problems, and manage expectations to ensure timely and accurate issue resolution
• As needed, may require working outside of normal business hours to complete time sensitive processes
• Other duties as assigned

Analyst, Tech Operations – Government Programs

• Support/back up the CSE, Senior CSC and CSC responsibilities
• Create and present data for Strategic Business Plans, VALUE Summaries, and Performance Standard reports
• Investigate/follow-up if Performance Guarantees are not met and present those results to their assigned clients
• Conduct Client training (Client Portal Site, Navi-Claim, etc.)
• Assist with escalated member/Client issues requests
• Identify and present Client opportunities to improve costs, service and health
• Contract maintenance and performance
• Travel to Client sites
• Provide mentoring to the coordinator levels and CSEs
• Other duties as assigned

Senior Client Services Executive – Navitus

• Request historical files from advisor or client, and review layout as needed.
• Host the TPA implementation meetings.
• Review data transmission process, file layouts, timing, etc..
• Determine system hierarchy requirements and build in CRM.
• Coordinate eligibility test files, updates, and production.
• Coordinate claims extracts with all vendors (TPA, stop loss, advisor).
• Coordinate ID card from TPA for approval.
• Validate eligibility files and extracts post go live.
• Conduit to the Navitus eligibility and claims extract teams.
• Manage data sharing policies and Non-Disclosure Agreements with vendors.
• Submit data and service requests, and ongoing monitoring to ensure accurate, timely completion.
• Troubleshoot any vendor issues to ensure quick resolution, including support of the account teams in helping to facilitate resolution of escalated file issues.
• Suggest and implement new vendor management processes, policies, and methods as needed.
• Identify and research expansion opportunities, in addition to growing the client base with existing consultant/broker/TPA relationships.
• Other duties as assigned

Vendor Manager, Client Operations

• Collaborate with analysts, developers, programmers, and designers in conceptualizing and development of software programs and applications
• Define, develop, and document software’s business requirements, objectives, deliverables, and specifications on a project-by-project basis in collaboration with internal users and departments
• Design, develop, document, and implement new applications and application enhancements according to business and technical requirements
• Assist in defining software development project plans, including scoping, scheduling, and implementation
• Recommend, schedule, and perform software improvements and upgrades
• Consistently design, write, translate, and code software programs and applications according to specifications
• Write new and modify existing programming scripts to enhance functionality and/or performance of company applications as necessary
• Design, run and monitor software performance tests on new and existing programs for the purposes of correcting errors, isolating areas for improvement, and general debugging
• Develop and maintain technical documentation and development guidelines
• Train end users to operate new or modified programs

Software Engineer

Analyst

• Prepare monthly finance accrual recommendations for review by Sr. Manager
• Responsible for maintaining and designing team SharePoint site and identifying opportunities for enhancements based on trending of team productivity and accomplishments to help ensure successful completion of team’s work and meeting Navitus’ strategic and business initiatives
• Accountable for data quality, completeness and accuracy in team workflow tools, including RFP/renewal deadlines and new client implementations
• Accountable for maintenance of frequently used resource documents on team SharePoint site, including performance guarantee library, FAQs, subject matter experts and standard performance guarantee contract exhibit
• Guide existing and train new contract performance analysts as well as inspire positive communication within the entire contract performance team to work together to achieve common goals
• Assist Contract Performance team with the Request for Proposal (RFP) process process which includes but is not limited to the following: Review RFP requested performance guarantees
• Compare to previously requested guarantees for consistency
• Present findings to Contract Performance team
• Perform outreach for departmental approval of performance guarantees
• Consolidate responses and review with Contract Performance team
• Deliver RFP response to Proposal team
• Upon Client win notification, review service, network and/or rebate guarantees agreed to during the RFP process and notify operational areas
• During contract negotiations, analyze contract redlines, perform outreach for departmental approval of any performance guarantee edits and prepare final recommendations
• Upon contract execution notification, communicate final contract guarantees to operational areas prior to go-live
• Responsible for Performance Guarantee (PG) reporting which includes but is not limited to the following: Monitor the collection of monthly, quarterly and annual service performance guarantee results from process owners
• Identify, research and facilitate corrective action for missed guarantees with the process owners and Client Services team and determine penalty payout when applicable
• Analyze underperformance in network financial performance reports and notify Pharmacy Networks team to solicit cause and next steps if needed
• Assists the Manager with the development, documentation, implementation, and maintenance of performance guarantee data repositories and report writing programs
• Prepare PG-related reporting for senior leadership as needed
• Schedule, facilitate and document meetings and discussions
• Participate as a member of cross functional workgroups, teams, and committees, as assigned
• Assist with the creation and maintenance of departmental work instructions
• Other duties as assigned

Senior Analyst, Contract Performance

General Counsel

• Dedication to being part of a high-performing team, providing exceptional legal services, and helping Archimedes continue to grow and develop.
• Provide analysis and counsel to Archimedes on legal issues related to contracts, statutes and regulations, products, employment law, intellectual property, financial offerings, financial structuring, real estate transactions, and strategic planning.
• Work collaboratively with Lumicera and Navitus teams to ensure compliance with relevant law, ethical business practices, and Navitus’ mission and values.
• Ensure the effectiveness and efficiency of the Archimedes Legal Team in meeting organizational needs.
• Draft, review, and negotiate contracts on behalf of Archimedes; maintain and proactively update contract templates in compliance with changing business needs and legal requirements; write and administer complex vendor, client, and employment contracts.
• Manage processes related to licensing and regulatory requirements for Archimedes.
• Inform the development of new Archimedes initiatives from a legal perspective and provide guidance on legal issues that help shape the organization’s direction and impact as a whole related to contracts and IT systems.
• Update, review and approve policies and procedures related to Archimedes legal needs.
• Research and analyze statutes, judicial decisions, legal articles, contracts, and legal codes as needed.
• Maintain a working knowledge of applicable state, federal, and local laws and regulations and relevant policies and procedures to ensure actions are consistent with Archimedes’ mission and values as well as organizational and professional ethical requirements.
• Other duties as assigned.

Assistant General Counsel

Human Resources

• Advise leaders on HR policies, performance management, and associate relations.
• Assist and lead investigations.
• Serve as consultant and first point of contact, assisting HR Generalists with escalated cases, coordinating with Sr. Manager or HRBP as needed.
• Oversee leave administration including Family Medical Leave Act (FMLA) and Americans with Disabilities Act (ADA) and manage complex cases.
• Advise HR Generalists and ensure compliance of all leave management and serve as key contact for escalated cases.
• Partner with Sr. HR Manager as needed.
• Facilitate the development and administration of programs, policies and processes that align with federal and state regulatory changes and meet compliance requirements ensuring an ethical, fair and consistent approach.
• Provide guidance on associate related issues (including but not limited to ADA, FMLA, FLSA, harassment, discrimination, diversity, corrective action and progressive discipline) to leadership.
• Analyze trends in turnover and performance; recommend solutions and partner with Sr Manager, HRBP, and HR Leadership on initiatives for improvement.
• Support and guide leadership with complex performance management.
• Coach, educate, provide feedback to leaders and lead disciplinary actions.
• Lead complex associate relations and conflict resolution efforts.
• Provide counseling and direction, facilitate communication, and help to resolve conflicts that impact associate’s engagement.
• Partner with leadership to improve working relationships, build morale, and increase engagement and retention.
• Support the development of HR Generalist and HR Coordinator team members through mentorship and training.
• Lead HR and process improvements initiatives across the enterprise in support with the Sr. HR Manager and HRBPs.
• Collaborate with other HR departments to ensure wholistic efforts.
• Ensure compliance with federal and state employment regulations.
• Make recommendations for alignment within policies and procedures when laws advance or change.
• Lead the associate handbook review and policy updates ensuring compliance with federal and state regulations.
• Partner with Legal department on complex changes and administration practices.
• Serve as liaison for audits and accreditation deliverables.
• Partners with HR Coordinator for document collection and preparations.
• Provide associate life-cycle assistance, administration and act as subject-matter-expert related to HR related questions and concerns.
• Other duties as assigned.