Coordinator I, Recoveries

The Recoveries Coordinator I position is responsible for reprocessing of claims of all levels of complexity to execute the claims adjudication process. The Coordinator will gain a beginners understanding, applying, and communicating client-specific benefits to manage the day to day processes and changes made to a client's benefit or a pharmacies' contract. This role requires knowledge of both the technical and operational sides of the business. Candidates will have direct authority to make sound business decisions with regard to processing of a claim. Candidates need to have a working knowledge of claims processing. The Coordinator will work closely with Member Services, Clinical Services, Client Services, Benefit Configuration, and Government Programs to understand the interdependences of each team pertaining to processing of claims. The Coordinator also needs to be able to support and mentor others as it relates to processing of claims.

This position may include after-hour and/or weekend hours with other eligible team members depending on workload. Description of the main focus and responsibilities of the job including team(s) the position interacts with.

Is this you? Find out more below!

How do I make an impact on my team?

Is responsible for successfully processing claims within the claims adjudication system for specified client performance guarantee timeframes, guarding client and Navitus from potentially high dollar financial liabilities
• Collaborates with requester insuring all appropriate information is received to process the request
• Creates, validates, and confirms large batch of claims prior to electronically processing
• Learn and abide by regulatory requirements to participate in Client, State, and Federal Audits which includes compilation of claim files, audit universes, report creation and analysis, validation of claim against benefit allowances, and responding to auditor questions verbally and in writing
• Assist in review and audit the outcome of the processed claim
• Assist in creating and maintaining internal team documentation and training materials
• Participates in process re-design of team initiatives
• Participates with communicating to all departments the nature of processing claims; providing talking points for Member Services to explain claim processing reimbursements to members and pharmacies, and Client Services or Government Programs to explain claim correction outcomes
• Runs necessary reports to analyze overall impact of request
• Other duties as assigned

What our team expects from you?

• High school degree or equivalent experience
• PBM or managed care is preferred, but not required
• Participate in, adhere to, and support compliance program objectives
• The ability to consistently interact cooperatively and respectfully with other employees

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