Sr. Consultant, Issue Management

Due to growth, we are adding a Sr. Issue Management Consultant to our CAO Quality department.

The Sr. 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 reported 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
• Collaborate with internal partners who conduct RCA to ensure accurate issue identification
• Own the Root Cause Resolution process to remediate reported issues
• Develop and implement action plans to prevent recurrence of issues
• Integrate preventative strategies into broader quality improvement initiatives
• Provide oversight of remediation efforts to ensure completeness and accuracy
• Write clear, consistent, and compliant business requirements to support issue resolution
• Focus on reprocessing Medicare, Medicaid, Commercial, and Exchange claims
• Centralize claims reprocessing efforts to reduce operational and compliance risk
• Investigate reported issues and determine appropriate remediation steps, including policy, procedural, or configuration changes
• Communicate findings and action plans clearly to client-facing teams
• Identify opportunities for process improvement based on RCA findings
• 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?

What can you expect from Navitus?

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