Analyst, Technical Operations Government Programs job at Navitus Health Solutions in Appleton, WI (Not hiring in SC, RI, NH, MS, WV, WY, ME, ND, SD, NM, AK, HI)
Title: Analyst, Technical Operations Government Programs Location: US-WI-Appleton ID 2025-5409 Category Information Technology Position Type Full-Time Remote Yes Job Description: 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 to be considered for internal opportunities. Pay Range USD $42,505.00 - USD $50,601.00 /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 7:30am to 4pm 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 Navitus Health Solutions is seeking an Analyst, Tech. Operations Government Programs to join our team! The Analyst, Tech. Operations Government Programs has responsibility for executing Government Programs processes accurately, efficiently, and in compliance with CMS regulations. Is this you? Find out more below! Responsibilities How do I make an impact on my team? 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 Qualifications What our team expects from you? Bachelor/Associate Degree in business related field; or equivalent of an associate degree and 2 years of work experience, or 4 years of work experience and a high school diploma or equivalent 1+ years' work experience Experience in pharmaceutical claims adjudication systems, retail pharmacy, or in a health plan organization is preferred Participate in, adhere to, and support compliance program objectives The ability to consistently interact cooperatively and respectfully with other employees What can you expect from Navitus? 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! Apply tot his job