Client Advocate

Location

US-

ID

2025-5292

Navitus

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.

USD $47,309.00 - USD $56,321.00 /Yr.

M-F 8am to 5pm

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.

Navitus Health Solutions is seeking a Client Advocate to join our team!

The Client Advocate (CA) acts as a hybrid of Account Representative and Case Manager to advocate on behalf of the client's pharmacy benefit program. The CA will field inbound escalation requests from client representatives such as benefit professionals or health care facilitators to assist with escalated member research cases. The CA will collect relevant information and work across the Navitus organization to identify, understand, and determine next steps for resolution. The CA may make outbound communications to members, prescribers and/or pharmacies to complete the research cycle and assist the client's members in understanding those next steps and provide white glove member service. The CA should be comfortable researching across departments on a multitude of topics, including, but not limited to, coverage determinations, manual claim submissions, recoveries, transition status, and overall claims adjudication results. The CA will become proficient in the Navitus claims processing system and Intranet. The CA will gain proficiency in understanding, applying, and communicating client-specific formularies, clinical programs, and other pharmacy benefit components.

Is this you? Find out more below!

How do I make an impact on my team?

Field inbound inquiries from benefit professionals, health care facilitators as a member of the broader client account team
• Research and analyze electronic and manual claims. Apply troubleshooting skills to resolve issues as allowed by the individual benefit, including entering and updating MPAs and submitting test claims
• Communicate prior authorization, exception, and appeals information to callers including required information, turn-around-times, and other applicable details
• Help educate, when appropriate, members how to navigate their benefit, including information regarding participating pharmacies, best utilization of their benefit, formulary explanations, patient pay amounts, benefit restrictions, and other information as applicable
• Documents and tracks status of inquiries and resolution in both NCRx and CRM
• Respond to and resolve all internal and external inquiries in a timely, accurate, and complete manner
• Protect all personal health information and abide by all HIPAA regulations and confidentiality requirements
• Other duties as assigned

What our team expects from you?

• A minimum of a high school degree or equivalent is required
• National Certification from an accredited pharmacy technician certification program approved by specific state regulations (e.g. PTCB, ExCPT, CPhT etc.). or Licensed Practical Nurse (LPN) degree or certificate preferred
• 5+ Years' previous experience working with members/patients
• Experience in a mail pharmacy, retail pharmacy or clinic/care setting desired
• Experience as a member of a multi-disciplinary team is preferred
• Knowledge of applicable data privacy practices and laws is preferred
• Participate in, adhere to, and support compliance program objectives
• The ability to consistently interact cooperatively and respectfully with other employees

Remote

US