If you like clean data, tight processes, and fixing what’s broken before it costs real money, this role lives right in that lane. You’ll help make sure pharmacy claims and reimbursements match contract agreements and that payment activity is accurate end to end.
About Navitus
Navitus is a people-first pharmacy benefits manager (PBM) built to remove cost from the drug supply chain and make medications more affordable. The culture leans collaborative, compliance-minded, and improvement-focused.
Schedule
- Full-time, remote
- Monday–Friday, 8:00am–5:00pm CT
- Remote work not available to residents of: Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming
What You’ll Do
- Administer technical processes supporting system price setups, EFT, and remittance setups according to policy
- Review and strengthen process controls and oversight reporting (and build new controls when gaps exist)
- Research and resolve pharmacy network pricing setup issues and pricing inquiries from pharmacies/internal teams
- Submit service requests for pharmacy network updates and audit networks for price change accuracy
- Test pharmacy network rates, analyze results, and assess business/financial impact
- Perform ongoing QA to confirm pharmacy network rate accuracy and reduce incorrect claims adjudication risk
- Identify and escalate improper payments and 835 remittance issues
- Support recoveries by providing offset details to impacted pharmacies prior to payment/remittance
- Monitor and report on non-compliance tied to overpayments, transaction standards, and financial regulations
- Maintain department work instructions and policies
- Produce and support reporting, metrics, data dictionaries, inquiries, and audits
- Build processes to import/export data across Navitus systems (including Pharmacy Credential and Contracting database and NCRx)
What You Need
- Associate degree preferred or equivalent experience
- CPhT preferred
- PBM or managed care experience preferred (not required)
- Testing experience preferred
- Strong investigation skills, comfort with audits/QA, and the ability to make independent assessments tied to contract reimbursement obligations
Benefits
- Health, Dental, and Vision insurance
- 20 days paid time off
- 4 weeks paid parental leave
- 9 paid holidays
- 401(k) match up to 5% (no vesting requirement)
- Adoption Assistance Program
- Flexible Spending Account
- Educational Assistance + Professional Membership assistance
- Referral bonus program (up to $750)
This is the kind of role where your resume has to scream: pricing setup support, QA/testing, reconciliation, reporting, and fixing payment issues. If you want, paste your current resume bullets and I’ll tailor them directly to this posting.
Happy Hunting,
~Two Chicks…