Analyst, Tech Operations – Government Programs

📋 Description

• Responsibilities may encompass one or more of the following: administration and oversight of Employer Group Waiver Plan (EGWP) enrollment, management of Retro-eligibility processes, Financial Information Reporting (FIR), Plan Finder Submission, Coordination of Benefits (COB), management of reject issues, Prescription Drug Event (PDE) error management and reconciliation, Medicaid Encounter Data, Affordable Care Act (ACA) Claims Submission, Explanation of Benefits (EOB), Retiree Drug Subsidy (RDS), and Claim Auditing.

• Supervise the timelines for the assigned processes, modify schedules as necessary to ensure deadlines are achieved, and notify management when timelines are at risk.

• Ensure that process documentation accurately represents the current procedures and make updates when required.

• Collaborate with subject matter experts (SME) to define and document process steps, providing insights on requirements for technical specifications.

• Analyze and investigate errors while prioritizing reconciliation efforts in alignment with State and Federal guidelines.

• Communicate effectively with Employer Groups, Clients, State/Federal Agencies, external vendors, and internal departments at Navitus to address action items, resolve issues, and manage expectations for timely and accurate outcomes.

• As necessary, may involve working beyond regular business hours to complete time-sensitive processes.

• Additional duties as assigned.

⛳️ Requirements

• Bachelor’s or Associate Degree in a business-related field; or an equivalent of an associate degree along with 2 years of professional experience, or 4 years of work experience with a high school diploma or equivalent.

• At least 1 year of professional experience.

• Preferred experience in pharmaceutical claims adjudication systems, retail pharmacy, or within a health plan organization.

• Actively participate in, comply with, and support compliance program objectives.

• Ability to interact consistently in a cooperative and respectful manner with other employees.

🏝️ Benefits

• Comprehensive benefits package for Health, Dental, and Vision insurance.

• 20 days of paid time off.

• 4 weeks of paid parental leave.

• 9 paid holidays.

• 401K company match of up to 5% with no vesting requirement.

• Adoption Assistance Program.

• Flexible Spending Account.

• Educational Assistance Plan and support for Professional Memberships.

• Referral Bonus Program – up to $750!