Configuration Analyst jobs in Appleton, WI

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.  

We are unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.

The Analyst I, Benefit Configuration position is responsible for analysis, interpretation, integration and business decisions with regards to hierarchy, pharmacy network rates and Navitus’ formulary configuration designs.   This position requires knowledge of both the technical and operational sides of the business utilizing Navitus’ adjudication system (NaviClaimRx) and/or other applications which includes software updates and enhancements. 

The Analyst I, Benefit Configuration will work closely with Provider Relations, Formulary Services and Client Services to understand the interdependence of each team pertaining to claims adjudication and client reporting needs. This position will ensure Navitus is able to provide a versatile adjudication system that allows for various benefit designs and accurate claim adjudication to adapt to the continuous changes in the pharmacy benefit industry.

Is this you? Find out more below! 

How do I make an impact on my team?  

• Analyze and implement requests including adjudication hierarchy, pharmacy network rates and formulary management configuration with a high degree of accuracy
• Import and validate Member Prior Authorization loads for new client implementations along with formulary updates for existing clients
• Perform quality assurance peer reviews on adjudication hierarchy, pharmacy network and formulary management configuration changes with a high degree of accuracy consistent with department work standards
• Serves as first line of support to troubleshoot adjudication inquiries to internal and external customers
• Accountable for pharmacy network rate build resolution and impact assessment
• Is responsible for complying with departmental standards along with established turnaround times
• Update and maintain existing departmental policies and procedures
• Comply with standards set forth regarding benefit design and configuration including HIPAA, NCPDP and Navitus internal business standards
• Utilize departmental workflow management, issue resolution and reporting tools
• Contribute towards departmental performance and service level guarantees and achieve individual performance goals around accuracy and timeliness

What our team expects from you? 

• Associates degree and/or a minimum of four years of work experience is required.  
• Two years of pharmacy technician experience is preferred
• Knowledge of NCPDP or Medispan is a plus
• 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 8:00am-5:00pm, 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