Navitus Health Solutions

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Benefit Configuration Analyst

at Navitus Health Solutions

Posted: 6/29/2019
Job Reference #: 5000504384106

Job Description

Requisition Number



Appleton Campus: Appleton, Wisconsin

Other Locations



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

Key Skills/Competencies:

  • Ability to prioritize continually/multi-task and manage in a fast-paced environment
  • Understanding and coping with constant change
  • Detail orientation
  • Strong analytical skills
  • Critical thinking/problem-solving
  • Judgment and decision-making
  • Ability to build and manage relationships
  • Ability to communicate effectively at all levels within the organization (written, verbal/presentation and active listening)
  • Skilled at working within a team-oriented, collaborative environment
  • Customer-centric skills, and ability to understand internal and external customers
  • Experience with core software applications, including Microsoft Word, Excel, Outlook, and PowerPoint
  • Strategic Thinking/Systems Aptitude
  • Ability to look for explanations of the current state without blaming other people

Job Description

Job Summary:

The Benefit Configuration Analyst I 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 Benefit Configuration Analysts I 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.

Job Responsibilities:

  • 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 work flow management, issue resolution and reporting tools
  • Contribute towards departmental performance and service level guarantees and achieve individual performance goals around accuracy and timeliness
  • Actively participate in and contributes to daily communications, team meetings and project/issue resolution
  • Assist in the development of process improvements that focus on efficiency and accuracy