Job Information
NAVITUS HEALTH SOLUTIONS LLC Specialist Claims Quality Assurance in MADISON, Wisconsin
JOB REQUIREMENTS: Specialist, Claims Quality Assurance Location US- ID 2026-5691 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._____________________________________________________________________________________________________________________________________________________________________________________________________________. Current associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities. Pay Range USD \$65,686.00 - USD \$79,140.00 /Yr. STAR Bonus % (At Risk Maximum) 5.00 - Salaried Non-Management except pharmacists Work Schedule Description (e.g. M-F 8am to 5pm) M-F 8am to 5pm CT Remote Work Notification ATTENTION: Navitus is 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. Overview Due to growth, we are adding a Claims Quality Assurance Specialist to our team. The Claims Quality Assurance Specialist ensures the accuracy and integrity of pharmacy benefit configurations through comprehensive audit and testing activities. This role performs recurring monthly quality validations for assigned clients, including test preparation, scenario design, adjudication testing, and detailed result analysis across multiple environments. The Specialist applies expertise in diverse plan designs and benefit structures across Commercial, Exchange, Medicaid, and Medicare Part D lines of business while collaborating closely with cross functional teams. The role requires strong analytical skills, attention to detail, adaptability to ongoing system and industry changes, and occasional after hours or weekend support based on testing demands. Is this you? Find out more below! Responsibilities How do I make an impact on my team? Execute monthly quality assurance testing cycles, including client group selection, high utilization drug identification, test member preparation, adjudication file execution, results import, analysis, and month over month comparison. Validate adjudication results against plan grids, formularies, configuration documents, and other sources of truth; prepare QA deliverables and submit... For full info follow application link. Navitus Health Solutions is an Equal Opportunity Employer: Disabled/Veterans/Male/Female/Minority/Other ***** APPLICATION INSTRUCTIONS: Apply Online: ipc.us/t/8CA57A64C6274EF5