Sr. Analyst, Eligibility Coach

Company

Work Schedule Description (e.g. M-F 8am to 5pm)

Remote Work Notification

Hiring Manager : Full Name: First Last

Overview

Due to growth, we are adding a Sr. Analyst, Eligibility Coach to our team!

The Sr. Analyst, Eligibility Coach ensures efforts are in alignment with the Claim Adjudication Operations (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. The Sr. Analyst, Eligibility Coach will work closely with Data Services, Claim Adjudication Technology, Implementation, and Account Management teams to understand the interdependences of each functional area.

The Sr. Analyst, Eligibility Coach requires knowledge of both the technical and operational sides of the business and will function as the lead eligibility resource for assigned clients, as well as a back-up resource for peer analysts when needed. The Sr. Analyst, Eligibility Coach will have direct authority to make sound business decisions regarding client eligibility data and will demonstrate the ability to continually prioritize day to day workload to meet individual, departmental, and organizational goals for service and performance. 

This position may include after-hour and/or weekend hours depending on workload. This position also includes after-hour and weekend on-call duties on a rotating basis with other team members.

Is this you? Find out more below!

Responsibilities

How do I make an impact on my team? 

• Analyzes, interprets, and makes business decisions related to highly complex client eligibility needs. This includes understanding client needs, monitoring electronic file loads and subsequent reports, ID card/booklet generation, reconciliation reporting, implementation activities and any additional eligibility related processes.
• Performs urgent eligibility additions, terminations, and changes timely and accurately to prevent member access to care issues, missed performance guarantees and potential liquidated damages.
• Works directly with client contacts and Navitus’ Account Management team and participates as lead eligibility subject matter expert in all assigned new client implementations and/or existing client change projects and all related meetings and communications.
• Uses self-directed, sound business judgment and expertise to identify, define and formulate root cause analysis of eligibility data or process issues. Documents supporting client test grids with issue-specific scenarios and makes recommendations for corrective action plans and process improvements.
• Adapts to industry changes evolving technology, maintaining an expert level of understanding of eligibility in both legacy and emerging products and systems.
• Initiates and leads process improvement, cost reduction and automation efforts. Independently assesses future business needs and brings recommendations to leadership.
• Collaborates with IT Business Analysts responsible for writing business requirements for projects and claim system enhancements involving highly complex eligibility processes. Conducts related release and regression testing to ensure quality and compliance with state, federal and client regulations/ standards.
• Generates queries and reports to monitor membership and identify/troubleshoot issues and completes performance guarantee and special eligibility reports requested by clients, leadership, CAO and other departments on an ad hoc basis.
• Develops eligibility content for client and sales presentations, actively participates in client demonstrations and responds to assigned RFP questions using subject matter expertise.
• Provides subject matter expert level recommendations and input into technical processes between operating departments and external partners.
• Functions as a subject matter expert (SME), the main source of contact and lead peer mentor.
• Recommends, creates, and conducts training within functional role for newer and experienced team members.
• Exhibits approachability and ensures collaboration across the team through the organization and facilitation of role-based meetings and other group discussions while maintaining relationships among peers.
• Other duties as assigned.

Qualifications

What our team expects from you?

• Associate’s degree or equivalent work experience required. 
• Full mastery of Navitus systems and processes of the role with ability to perform tasks independently and follow instructions to make decisions required, typically with 4 or more years of experience.
• Experience with guiding and educating associates within current to lower-level roles.
• Experience within high-level planning and decision making.
• Experience with supporting highly complex/custom health plan business.
• Experience with the following tools at an advanced to expert level:
  • Navi-ClaimRx
  • Microsoft Office (Word, Excel, PowerPoint, Dynamics (CRM))
  • Text Editing (Notepad++/UltraEdit)
  • Request Management (Connectus, Service Desk, Responsive)
  • Reporting (3D QlikView/QlikSense, SQL Server, SAS)
  • Government Programs Error Management (GEMS)
  • FTP File Transfer/Retrieval (FileZilla)
• 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? 

• 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! 

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