If you like clean processes, tight controls, and figuring out why the money doesn’t match the contract, this is your lane. You’ll help ensure pharmacy claims adjudicate correctly, remittances are accurate, and overpayments get identified, escalated, and recovered.
About Navitus
Navitus is a people-first Pharmacy Benefit Manager (PBM) built to remove cost from the drug supply chain and make medications more affordable. They promote a collaborative culture that values diversity, growth, and strong customer service.
Schedule
- Full-time, Remote
- Monday to Friday, 8:00 AM to 5:00 PM CT
- Pay range: $47,309 – $56,321 per year
- Bonus: 5% (at-risk maximum)
- Remote restriction: Not available to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, or Wyoming
What You’ll Do
- Administer technical processes supporting pricing setups, EFT, and remittance setups according to policy
- Ensure controls and oversight reporting exist end-to-end, and create new controls when they don’t
- Research and resolve pharmacy network pricing setup issues and pricing inquiries (pharmacies + internal teams)
- Submit service requests for needed network updates
- Test pharmacy network rates, analyze results, and assess claim impact
- Perform ongoing QA audits to confirm network rate accuracy and reduce incorrect adjudication risk
- Identify and escalate improper payments and 835 remittance issues
- Support pharmacy remittances: EFT accuracy, 835 remittance advice accuracy, and recovery oversight
- Manage recovery workflows for pharmacies in negative balance status (recoupment)
- Provide pharmacies with offset details for recovery projects before payment/remit receipt
- Build/import/export data processes across Navitus systems (including Pharmacy Credential & Contracting database and NCRx)
- Maintain department work instructions and policies
- Monitor and report non-compliance tied to overpayments, transaction standards, and financial regulations
- Own/support financial and metrics reporting, data dictionaries, inquiries, and audits
- Other duties as assigned
What You Need
- Associate degree preferred (or equivalent experience); CPhT preferred
- PBM or managed care experience preferred (not required)
- Testing experience preferred
- Strong judgment and ability to independently confirm reimbursement aligns with pharmacy contract terms
- Comfort with detailed reporting, audits, and process documentation
- Ability to collaborate across teams (Provider Relations, IT Client Operations, etc.) and communicate clearly
Benefits
- Health, Dental, Vision
- 20 days PTO
- 4 weeks paid parental leave
- 9 paid holidays
- 401(k) match up to 5% (no vesting requirement)
- Adoption assistance
- Flexible Spending Account
- Educational assistance + professional membership support
- Referral bonus program (up to $750)
Reality check: this isn’t “basic admin.” It’s reimbursement ops with contracts, pricing logic, and error-hunting. If your resume doesn’t show audits, reconciliations, QA/testing, or financial controls, you’ll want to reframe your experience to match that.
Happy Hunting,
~Two Chicks…