Returning Candidate? Log back in! Analyst I, SIU Location US- ID 2025-4670 Category Administration Position Type Full-Time Remote Yes 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. Pay Range USD $58,460.48 - USD $70,434.33 /Yr. Work Schedule Description (e.g. M-F 8am to 5pm) M-F 8 am - 5 pm Remote Work Notification ATTENTION: Navitus is unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming. Overview

Navitus Health Solutions is seeking a SIU Analyst I to join our team!

 

The SIU Analyst position is responsible for conducting moderate to complex research using internal and external databases to perform analyses and develop recommendations on suspected fraud, waste, and abuse related to members, prescribers, pharmacies, and clients. In addition, the Analyst is responsible for regular and proactive extraction and evaluation of mined data, scoping data for investigations, and responding with reports and data for audits, universes, and impact assessments. The Analyst will coordinate and support data requests from third parties regarding fraud, waste, and abuse. The Analyst will also process and assess data produced by vendors, health plans, and third parties for analysis and comparison with Navitus claims. The Analyst will remain current on the regulatory environment and trends associated with fraud, waste, and abuse including changes directly or indirectly impacting Navitus Health Solutions, LLC. The Analyst will also assist the Associate Director, Compliance and SIU with duties related to analytic criteria, data tools, metrics calculation, and reporting of results.

 

Is this you? Find out more below!

Responsibilities

How do I make an impact on my team? 

Under limited supervision perform timely research and analyses to initiate and support investigations and business operationsAnalyze and validate claims data, reports and datasets for value, variance, and content to escalate for investigation of potentially fraudulent trends and patternsEvaluate data and report findings for accuracy, completeness, intent, and scopeCoordinate data from internal databases and/or external data sourcesTrack and monitor data, analysis and documentation for retrieval and coordination with investigationsDevelop reports and support clients on fraud, waste, and abuse universe prep and impact analysisMaintain tables, tools, or reports associated with data mining, data imports, and universe prepCoordinate metrics and performance reporting for fraud, waste, and abuse program activitiesFacilitates and/or participates in process re-design, service improvement, cost reduction and automationOther duties as assigned Qualifications

What our team expects from you?

Bachelor’s Degree or a combination of education and relevant work experience is required. Pharmacy Technician certification strongly desired. Must be willing and able to work towards professional designations related to analysis and/or investigation of fraud, waste and abuse2-4 years with working data analytics in a healthcare or pharmacy benefits management environment. Knowledge of state and federal privacy laws and protocols a plus. Participate 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 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  #LI-Remote Location : Address Remote Location : Country US Options ApplyApplySubmit a ReferralRefer Sorry the Share function is not working properly at this moment. Please refresh the page and try again later. Application FAQs

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