Product Manager, Claim Adjudication (GP)

Company Navitus About Us Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other._____________________________________________________________________________________________________________________________________________________________________________________________________________. Current associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities. ____________________________________________________We are committed to providing equal employment opportunity to all applicants and employees and comply with all applicable nondiscrimination regulations, including those related to protected veterans and individuals with disabilities. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or handicap. Pay Range USD $82,586.00 - USD $101,333.00 /Yr. STAR Bonus % (At Risk Maximum) 5.00 - Salaried Non-Management except pharmacists Work Schedule Description (e.g. M-F 8am to 5pm) M-F 8am to 5pm CT Remote Work Notification ATTENTION: Navitus is unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming. Overview Due to growth, we are adding a Claims Adjudication Product Manager (CAPM) to our team. The Claims Adjudication Product Manager (CAPM) is responsible for ensuring Med D, Medicaid, and Exchange claims are adjudicating per CMS regulations as well as specific client needs. The CAPM will collaborate with other Navitus teams to ensure that the appropriate software, procedures, and oversight monitoring are implemented and operational in support of an environment of continuous improvements with claims adjudication. Is this you? Find out more below! Responsibilities How do I make an impact on my team? Champion and maintain a proactive internal audit process to verify claims are adjudicating as expected. Conduct root cause analysis to minimize future defectsWhen adjudication issues are discovered, champion root cause analysis efforts of these issues in support of continually lowering our adjudication Defects per Million opportunitiesWork closely with Recoveries Product Manager to verify recoveries projects produce the expected results as well as to improve the overall accuracy of the adjudication processOversee all adjudication-related fixes/enhancements. This includes oversight of system requirements development, and testingEnsure post-implementation monitoring processes are in place to validate adjudication-related fixes/enhancements are working as expectedServe as subject matter expert for claims adjudication-related questions and system enhancementsOversee timely completion of Acumen audit responses and leverage these results to improve claim adjudication accuracyEnsure metrics are monitored and reportedCreate and maintain claim adjudication training resourcesOther duties as assigned Qualifications What our team expects from you? College degree or equivalent experience required in managed care or health insuranceMinimum of two years’ experience with Medicare claims adjudication preferredHas successfully lead root cause analysis projectsProject Management and/or Business Analyst experience a plusData analysis experience a plusOn-call availabilitySome travel may be requiredParticipate in, adhere to, and support compliance program objectivesThe ability to consistently interact cooperatively and respectfully with other employeesWhat can you expect from Navitus?Top of the industry benefits for Health, Dental, and Vision insurance20 days paid time off4 weeks paid parental leave9 paid holidays401K company match of up to 5% - No vesting requirementAdoption Assistance ProgramFlexible Spending AccountEducational Assistance Plan and Professional Membership assistanceReferral Bonus Program – up to $750!#LI-Remote  Location : Address Remote Location : Country US