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Claims Operations Specialist - Archimedes at Navitus in Brentwood, TN
Skills
Job Description
Company
ArchimedesAbout Us
Archimedes - Transforming the Specialty Drug Benefit - Archimedes is the industry leader in specialty drug management solutions. Founded with the goal of transforming the PBM industry to provide the necessary ingredients for the sustainability of the prescription drug benefit – alignment, value and transparency – Archimedes achieves superior results for clients by eliminating tightly held PBM conflicts of interest including drug spread, rebate retention and pharmacy ownership and delivering the most rigorous clinical management at the lowest net cost. .______________________________________________________________________________________________________________________________________________________________________________________________________. Current associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities.Pay Range
USD $0.00 - USD $0.00 /Yr.STAR Bonus % (At Risk Maximum)
0.00 - IneligibleWork Schedule Description (e.g. M-F 8am to 5pm)
M-F 8am - 5pmOverview
Based on our rapid growth, we are expanding our operations team at an exciting time in our history. The Claims Operations Analyst will be a key member of the operations team supporting pharmacy data management, process improvement, and problem resolution. The ideal candidate will be a self-starter, eager to learn as well as contribute, and be willing to drive end to end processes with all levels of the organization. Given our continued growth trajectory, we are looking for someone who can grow with the company’s core operations and become a key individual contributor.
The Claims Operations Analyst will be responsible for working with internal and external partners to help manage the many moving parts of client data integration for our book of business. This position will work on operational issues, analyze, and identify solutions to resolve issues in benefit setup, claims processing, member eligibility and benefit accumulators as well as other potential operational gaps identified.
Responsibilities
- Manage day-to-day process (i.e. audit benefit accumulator files, work daily reject and QA reports; escalate as needed.
- Troubleshoot and perform research on data integration issues, JIRA tickets, and escalations.
- Support client readiness activities through participation in development and approval of testing, training, communication, and business process changes.
- Translate business needs and processes into clear and concise procedural documentation with minimal guidance; ensure all documents are present and cataloged properly.
- Regularly monitor client implementation activities, identify, and escalate any at-risk milestones.
- Support the reporting needs of the department; develop and deliver reporting on an as-needed basis.
- Ensure compliance with the organization’s strict data sharing and confidentiality guidelines.
- Manage member and pharmacy related requests via Jira and resolve within the agreed upon SLAs
Qualifications
- Recent graduate of a bachelor’s degree program, or equivalent
- Knowledge of benefit accumulators, eligibility, and data extracts preferred.
- Demonstrate effective adaptability to new technology.
- Problem solving and analytical skills.
- Proficient in Microsoft Windows, Excell and PowerPoint; SQL a plus
- Interpret and use knowledge, facts, and data in problem solving.
- Ability to work within a team structure, negotiate and manage conflict.
- Strong communication skills (written and oral forms)
- Strong organization, prioritization, and management skills to manage multiple initiatives with effective and accurate results.
- Execute duties with the highest regard for integrity.