Due to growth, we are adding a Product Manager, Claim Adjudication Operations (CAO) to our team.

The Product Manager, Claim Adjudication Operations (CAO) will ensure 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 collaborate closely with customers for product discovery and definition, will identify product goals, and make recommendations for product enhancements. 

The Product Manager, CAO will also work closely with product owners to provide product knowledge and support for the development, testing and implementation of new products and enhancements. This role is also responsible for ensuring all assigned products adhere to industry best practices, support client needs, fulfill regulatory requirements and meet performance guarantees. The Product Manager, CAO will identify risks within assigned products and will apply subject matter expertise in the development of mitigation plans.

This position may include after-hour and/or weekend hours with other eligible team members depending on workload.

Is this you? Find out more below!

How do I make an impact on my team? 

• Functions as a subject matter expert and point of contact for business leads, stakeholders and operational users of assigned products.
• Develops an advanced level of understanding of assigned products to effectively collaborate on their refinement and expansion.
• Shares product knowledge and needs with product owners to assist in their development of requirements, test plans, and execution efforts for assigned product enhancements.
• Communicates assigned product activities and advancements to business stakeholders and product owners, as well as CAO leaders and role coaches.
• Independently assesses business needs for process improvements, cost reduction and automation efforts and brings recommendations to leadership.
• Develops, documents and conducts user training for new or enhanced products.
• Provides internal or client presentation content for assigned products and participates as a subject matter expert in product demonstrations.
• Other duties as assigned

What our team expects from you?

• Bachelor’s degree or equivalent work experience
• Knowledge of Navitus systems and processes of the role with ability to perform tasks independently and follow instructions to make decisions required, typically with 2 years of experience.
• Experience with guiding and education associates within current to lower-level roles.
• Experience with supporting mid-sized to large clients with moderate to high complexity.
• Experience with supporting health plan business with minimal guidance.
• 3 years of experience in the pharmacy benefit management industry preferred.
• Experience with claim adjudication operations preferred.
• Experience with the following tools at an intermediate to advanced level preferred:
  • Microsoft Tools (Word, Excel, PowerPoint, Visio, Azure DevOps)
  • Request Management (Service Desk, Connectus, Responsive)
  • Reporting (3D QlikView/QlikSense, CRM)
  • Other tools specific to functional area(s) of focus (e.g., NaviClaimRx)
• 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!

#LI-Remote