Consultant, Issue Management

Consultant, Issue Management

Location

US-

ID

2025-5082

Category

unsure

Position Type

Full-Time

Remote

Yes

Company

Navitus

About Us

Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other._____________________________________________________________________________________________________________________________________________________________________________________________________________. Current associates must use SSO login option at https : / / employees-navitus.icims.com / to be considered for internal opportunities.

Pay Range

USD $61,968.00 - USD $74,660.00 / Yr.

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

M-F 8am to 5pm CT

Remote Work Notification

ATTENTION : Navitus is unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.

Overview

Due to growth, we are adding

an

Issue Management Consultant to our CAO Quality department

The Issue Management Consultant plays a critical role in

identifying

, analyzing, and resolving claim adjudication issues to ensure accuracy, compliance, and operational efficiency. This position focuses heavily on claims reprocessing, risk mitigation, and requirement documentation, serving as a key liaison between internal business units and external clients.

Is this you? Find out more below!

Responsibilities

How do I make an impact on my team

Investigate issues to

identify

underlying root causes.

Apply RCA methodologies such as the 5 Whys to uncover systemic problems.

Document findings and produce comprehensive RCA reports.

Develop and implement action plans to prevent recurrence of issues.

Monitor the effectiveness of preventative actions and adjust as needed.

Integrate preventative strategies into broader quality improvement initiatives.

Maintain detailed records of issues, actions taken, and outcomes.

Provide oversight of remediation efforts to ensure completeness and accuracy.

Manage end-to-end issue tracking and testing to

validate

resolution.

Identify

opportunities for process improvement based on RCA findings.

Collaborate with internal teams to refine RCA and preventative action methodologies.

Write clear, actionable business requirements to support issue resolution and system enhancements.

Apply knowledge of claims processing workflows, systems, and procedures, including adjudication, resolution, and documentation standards, to ensure accuracy and compliance

Other duties as assigned

Qualifications

What

our

team

expects

from you?

Bachelor's degree or equivalent work experience

required

2+ years of experience

required

in root cause analysis, issue management, and preventative action planning within the PBM or healthcare industry

Experience with RCA tools and methodologies

Demonstrated knowledge of claims processing workflows, systems, and procedures, including adjudication, resolution, and documentation standards is

required

Proficiency

in Microsoft Office Suite

Knowledge of regulatory requirements and industry standards in PBM

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

ealth,

ental,

and V

ision insurance

20 days

aid

ime

ff

4 weeks paid parental leave

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

Location : Address

Remote

Location : Country

US

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