Returning Candidate? Log back in! Coordinator, Manual Claims Location US- ID 2025-4519 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. Pay Range USD $18.67 - USD $21.96 /Hr. Work Schedule Description (e.g. M-F 8am to 5pm) M-F 8am to 5pm 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 Manual Claims Coordinator to join our team!

 

The Coordinator, Manual Claims ensures efforts are in alignment with the Claim Adjudication Operations (CAO) team to leverage technology and process improvement for the purpose of meeting the business needs of Navitus customers, clients, members, and pharmacies by accurately administering benefits. This position is responsible for processing of pharmacy and/or direct member reimbursement (DMR) claims of all levels of complexity to execute the claims adjudication process including correction of claims.

 

This position may include after-hour and/or weekend hours depending on workload.

 

Is this you? Find out more below!

Responsibilities

How do I make an impact on my team? 

Accurately processes claims within the claims adjudication system within specified client performance guarantee timeframes, guarding client and Navitus from potentially high dollar financial liabilitiesAcquires and maintains a basic understanding of Navitus’ claims adjudication system, plan designs and upstream/downstream processes. Interprets client specific rules to ensure quality and accuracy of processingManages intake, scanning and categorization of inbound mail. Processes and mails outbound letters to members and pharmaciesCreates, validates and confirms large batches of claims prior to electronic processingLearns and abides by HIPAA and other regulatory requirements to participate in client, compliance, and state/federal audits. Includes compilation of claim files, audit universes, report creation and analysis, validation of claims against benefit allowances and responding to auditor questions verbally and in writingParticipates in new client implementations and supports existing clients of low to moderate complexity, acting as the representative for manual claims in all related meetings and communicationsAssists in the creation and ongoing maintenance of departmental training materials, work instructions and policiesCommunicates the nature of processing claims with all departments, providing talking points for Member Services to explain claim processing reimbursements to members and pharmacies, and Client Services or Government Programs to explain claim correction outcomesOther duties as assigned Qualifications

What our team expects from you?

Associate degree or equivalent work experienceBasic experience with Microsoft Office, specifically Word and ExcelParticipate 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

 

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