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.
The Coordinator, Eligibility ensures efforts are in alignment with the IT Client Operations team to support customer-focused objectives and the IT Vision, a collaborative partner delivering innovative ideas, solutions, and services to simplify people’s lives. The Coordinator, Eligibility position is responsible for successful coordination of member data for both electronic and immediate manual Client Eligibility and ID Card/Booklets needs. This role requires knowledge of both the technical and operational sides of the business. Candidates will have direct authority to make sound business decisions with regard to eligibility and demographic member data used in claim adjudication.
This position may include after-hour and/or weekend hours depending on workload. This position also includes after-hour and weekend on-call duties on a rotating basis with other team members.
Is this you? Find out more below!
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How do I make an impact on my team?- Is responsible for oversight of successful automated eligibility file loads to the Claim Adjudication System within specified client performance guarantee timeframes, guarding client and Navitus from potentially high dollar financial liabilities
- Perform manual data entry of eligibility adds, terms, and changes timely and accurately to prevent access to care issues that may lead to missed performance guarantees and ultimately liquidated damages
- Report all errors to Client contacts and/or Account Management within one business day of automated file loads
- Request, validate, and confirm full file data feeds from clients to ensure system integrity through audits and reconciliation, and independently assesses business needs for Navitus system improvements or recommends solutions directly to clients’ IT personnel using sound business judgment
- Conduct regularly scheduled claims adjudication system release regression testing for assigned client eligibility functions
- Is responsible to monitor internal and external Eligibility and ID Card/Booklet data documentation and training material
- Facilitate and/or participate in process re-design, service improvement, cost reduction, and automation, making business decisions that ensure prevention of missed client performance guarantees
- Utilize self-directed, sound business judgment and expertise to validate Eligibility providing necessary detail to other departments to make claims corrections and adjustments
- Update all detailed work instruction documentation and communicate to all departments the nature of each process of Eligibility, COB, and ID Cards/Booklets, providing talking points for Member Services to explain changes to members and pharmacies, and Account Management to explain changes to clients
- Assist teammates with troubleshooting, root cause analysis, and solution implementation for eligibility issues
What our team expects from you?
- Associate degree or equivalent work experience required
- Minimum one (1) year of experience in pharmaceutical eligibility, claims adjudication systems, retail pharmacy, or health insurance 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?
- Hours/Location: Monday – Friday 10:30am-7:00pm CST, Remote
- Paid Volunteer Hours
- Educational Assistance Plan and Professional Membership assistance
- Referral Bonus Program – up to $750!
- Top of the industry benefits for Health, Dental, and Vision insurance, Flexible Spending Account, Paid Time Off, Eight paid holidays, 401K, Short-term and Long-term disability, College Savings Plan, Paid Parental Leave, Adoption Assistance Program, and Employee Assistance Program
