[Hiring] Supervisor, Claim Adjudication Operations @Navitus Health Solutions, LLC

Role Description

Due to growth, we are adding a Supervisor, Claim Adjudication Operations to our team. The Supervisor, Claim Adjudication Operations (CAO) ensures efforts are in alignment with the CAO team to leverage technology and process improvement for the purpose of meeting the business needs of Navitus customers, clients, members and pharmacies by accurately administering benefits. This role will plan, design, coordinate and align resources to support the daily activities of the team. The Supervisor, CAO role will work closely with their team to identify, recommend, develop, implement, support, and improve customer-focused solutions.

Responsibilities

• Oversee roles within the Claim Adjudication Operations department to support accurate and timely configuration and data transfers of client hierarchy, benefits, and networks.
• Provide superior customer service utilizing a high-touch, customer centric approach focused on collaboration and communication.
• Outreach and collaborate with CAO customers/partners for day-to-day work and contribute to action plan creation.
• Oversight of work on Kanban boards, meeting turnaround times and performance guarantees.
• Run department Kanban board(s) and huddles, including sizing of work requests.
• Resource assignment of day-to-day work, audits, and root cause analysis/CAP.
• Perform 1:1s to elicit feedback from department associates, provide mentorship, discuss career development, address performance, and provide workload and project guidance.
• Perform workforce management duties for direct reports, including, but not limited to, overtime needs, time out of the office and time tracking.
• Apply soft skills toward team members and external stakeholders alike in understanding every point of view and coming to the table with good negotiation skills.
• Adhere to department level objectives to ensure alignment with division and company strategic initiatives.
• Participate in, adhere to and support compliance and diversity, equity, and inclusion program objectives.
• Other duties as assigned.

Qualifications

• Bachelor’s degree or equivalent work experience is required.
• 4 years of Navitus experience in an operations or leadership role, OR 4 years of external leadership experience, preferably with a strong background in operations, required.
• Knowledge of one or more responsibilities as defined above is strongly preferred.
• Professional PBM industry work experience is preferred.
• Knowledge of applicable data privacy practices and laws is preferred.
• Healthcare industry practices and HIPAA knowledge would be a plus.
• Experience as a member of a multi-disciplinary team is a plus.
• Understanding of human resource management principles, practices, and procedures would be a plus.
• Participate in, adhere to, and support compliance program objectives.
• The ability to consistently interact cooperatively and respectfully with other employees.

Benefits

• Top of the industry benefits for Health, Dental, and Vision insurance.
• 20 days paid time off.
• 4 weeks paid parental leave.
• 9 paid holidays.
• 401K company match of up to 5% - No vesting requirement.
• Adoption Assistance Program.
• Flexible Spending Account.
• Educational Assistance Plan and Professional Membership assistance.
• Referral Bonus Program – up to $750!

Company Description

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.