Note: The job is a remote job and is open to candidates in USA. Navitus Health Solutions is a pharmacy benefit manager committed to making medications more affordable by reducing costs in the drug supply chain. The Analyst III, Network Configuration configures pharmacy networks in the claim adjudication system, ensures accurate and timely claims processing, and supports diverse network designs. The role collaborates across departments, performs quality assurance and troubleshooting, and leads process improvement, automation, and training initiatives.

Responsibilities

• Complete scheduled and urgent configuration of new client implementations and/or network additions, terminations, and changes timely and accurately to prevent member access to care issues, missed performance guarantees, and potential liquidated damages
• Acquire and maintain an advanced level of knowledge and interpretation of multiple adjudication system screens and functions on a field-by-field level to design both standard and custom configurations to meet client expectations
• Comply with standards set forth regarding network design and configuration including HIPAA, NCPDP, and Navitus internal business standards
• Perform quality assurance peer reviews of network plan additions and changes with a high degree of accuracy. Research root cause of issues, troubleshoot viable resolutions, and make recommendations for corrective action
• Use departmental workflow management, issue resolution, and reporting tools for troubleshooting and responding to highly complex customer questions and issue resolution requests
• Support internal customers by participating in client meetings, audits, and new program implementations with other areas of the company, answering network setup questions and providing guidance to other areas and roles on the network configuration process
• Adapt to industry changes and evolving technology, maintaining an advanced level of understanding of both legacy and emerging products and systems
• Lead process improvement, cost reduction, and automation efforts. Independently assess future business needs and bring recommendations to leadership
• Contribute to the creation and ongoing maintenance of departmental training materials, work instructions, and policies. Provide support for client and sales presentations and respond to assigned RFP questions using subject matter expertise
• Other duties as assigned

Skills

• Associate's degree or equivalent work experience required
• Strong knowledge of Navitus systems and processes of the role with ability to perform tasks independently and follow instructions to make decisions required, typically with 2-3 years of experience
• Experience with the following tools at an intermediate to advanced level: + Navi-ClaimRx + Microsoft Office (Word, Excel, PowerPoint) + Formulary Management + Request Management (Connectus, Service Desk, Responsive) + Government Programs Error Management (GEMS) + Reporting (3D QlikView/QlikSense)
• Participate in, adhere to, and support compliance program objectives
• The ability to consistently interact cooperatively and respectfully with other employees
• Experience with guiding and educating associates within current to lower-level roles
• Experience with supporting mid-sized to large clients with moderate to high complexity
• Experience with supporting health plan business with minimal guidance

Benefits

• Remote work
• 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!

Company Overview

Company H1B Sponsorship