Benefit Systems Architect I
Navitus Health Solutions - Appleton, WI

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Education: An associate degree or equivalent work experience is required. Pharmacy Technician or similar experience is preferred .

Experience: Two (2) years of pharmacy technician experience is preferred. One (1) to two (2) years of experience in the administration and maintenance of a large and table driven application is required. Strong background in effective communication is required. Ability to analyze and interpret data quickly in a real time and dynamic environment is necessary. Ability to plan, organize, prioritize, and focus on outcomes is critical. Requires high level of initiative and creativity as well as intermediate to expert knowledge of the Microsoft Office Suite. Knowledge of Medicare D regulatory requirements required prior to or soon after hire. Role requires a desire to deliver quality service to internal and external customers. Required ability to multi-task and re-focus based on priorities. Knowledge of pharmaceutical claims adjudication, NaviClaimRx system, or a CRM is a plus.

Job Summary:

The Benefit System Architect is responsible for performing tasks related to the setup and maintenance of Navitus’ pharmacy claims system (NaviClaimRx and/or other applications). The primary functions of this position involve ensuring Navitus is able to provide a versatile adjudication system that allows for various benefit designs, accurate claim adjudication, and the implementation and maintenance of system upgrades and enhancements.

Responsibilities of this position include maintaining current benefit designs in the claims processing system; handling pharmacy or other system issues with clients and internal users, providing assistance to the implementation team, customer care department, or others concerning the implementation of new clients. This position also involves maintenance of the pharmacy networks and formularies; maintaining current pricing schedules, and maintaining and enhancing client plans after go live.

Job Responsibilities:

· Maintain benefit designs of current clients with a high degree of accuracy

· Perform quality assurance of changes

· Perform quality assurance of new client benefit designs

· Implement new client benefit designs as outlined by Implementation Coordinators/Implementation Project Managers

· Comply with standards set forth regarding benefit design

· Test claim adjudication software application enhancements with a high degree of accuracy

· Achieve department service levels as outlined by the Supervisor, Benefit Systems

· Participate in team meetings and project/issue resolution related meetings

· Utilize work flow management tools that are currently in place to achieve success

· Maintain open lines of communication with other functional areas/departments

· Maintain an outstanding level of customer service for clients and internal users

· Assist in the development of process improvements

· Support Navitus’ vision, mission, values, goals and policies

· Foster a culture of trust, respect and honesty

Navitus Health Solutions - 2 years ago - save job
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Navitus Health Solutions provides pharmacy benefit services to a variety of clients including health plans and self-funded employer groups....