• Manage team members in the delivery of benefit configuration, testing, and documentation aspects of the plan build and maintenance responsibilities to drive the highest level of performance and meet or exceed service level agreements. • Manage employee performance through defined employee scorecards and performance metrics. • Provide ongoing feedback and coaching to ensure performance targets are met, providing appropriate levels of direction and support to your team members as needed. • Schedule employees, track productivity, maintain work schedules, coordinate different activities, and approve time off and overtime. • Participate in initiatives to support process/workflow improvements, leverage new system capabilities within work processes, and consistently institute best practices within the function. • Work with clients, identifying and understanding benefit plan requirements. Build and maintain pharmacy benefit plans for client groups. • Own all aspects of benefit configuration organization and structure for accounts by monitoring plan data integrity. • Provide leadership support to team members for escalations and complex configuration requests. • Communicate to leadership on project status, escalating issues when appropriate, and drive changes to improve workflow efficiency. • Be accountable for ensuring review and resolution of inquiries from internal teams such as member support and customer success are completed timely to improve member experience.

• Lead a globally distributed team of QAE’s, SET’s, and Automation Engineers working on a world-class platform consisting of data processes, micro services and web applications built using cloud native technologies. • Establish a strong connection between customer scenarios and pre-release test coverage and automation. • Lead design and building of automated tests for Nextech’s products. • Automate the right tests at the right level: unit, integration, contract, API and UI. • Evangelize quality engineering best practices with Product, Development and DevOps teams around testing roadmap, tools and framework. • Establish quality assurance best practices and benchmarks and drive adoption across the QA team. • Drive continuous improvements in product testing processes (test plans, automation, testing resources, etc.) • Own Load Testing initiative to ensure our platforms scale effectively and we maintain the highest level of availability. • Drive transformation for enterprise performance testing and engineering framework. • Improve product delivery cycles through the integration of testing into the agile delivery cycle. • Empower team to learn and grow and support them in their career goals. • A willingness to work on additional tasks and responsibilities that will positively contribute towards team, department, and company goals. • Prioritize multiple competing priorities.

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 $65,686.00 - USD $79,140.00 /Yr. STAR Bonus % (At Risk Maximum) 5.00 - Salaried Non-Management except pharmacists 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 a Claims Quality Assurance Specialist to our team. The Claims Quality Assurance Specialist ensures the accuracy and integrity of pharmacy benefit configurations through comprehensive audit and testing activities. This role performs recurring monthly quality validations for assigned clients, including test preparation, scenario design, adjudication testing, and detailed result analysis across multiple environments. The Specialist applies expertise in diverse plan designs and benefit structures across Commercial, Exchange, Medicaid, and Medicare Part D lines of business while collaborating closely with cross functional teams. The role requires strong analytical skills, attention to detail, adaptability to ongoing system and industry changes, and occasional after hours or weekend support based on testing demands. Is this you? Find out more below! Responsibilities How do I make an impact on my team? - Execute monthly quality assurance testing cycles, including client group selection, high utilization drug identification, test member preparation, adjudication file execution, results import, analysis, and month over month comparison. - Validate adjudication results against plan grids, formularies, configuration documents, and other sources of truth; prepare QA deliverables and submit discrepancies for resolution. - Design comprehensive test scenarios using live claim sampling, client issue history, and financially impactful drug categories to ensure adequate coverage. - Develop and apply working knowledge of Navitus audit methodologies and end to end pharmacy benefit workflows to identify quality risks and downstream impacts. - Identify, document, track, and retest defects as fixes are applied; support root cause analysis and resolution efforts. - Perform peer reviews and quality checks to ensure adherence to audit criteria, validation standards, and business rules. - Utilize QA and workflow tools (e.g., Qlik Sense, RxFlex, FBMS) to troubleshoot and resolve moderately complex adjudication and configuration issues. - Maintain an intermediate understanding of adjudication systems, testing environments, and quality assurance methodologies. - Participate in process improvement initiatives, documentation updates, training material development, automation efforts, and standardization activities. - Other duties as assigned. Qualifications What our team expects from you? - Bachelor’s degree or equivalent work experience is required. - Pharmacy Technician License or National Certification preferred. - 5+ years of experience in quality assurance, benefit configuration, or data validation roles within a pharmacy benefit management (PBM) or similar payer environment required. - Experience supporting clients in all lines of business of varying size and complexity preferred. - Intermediate proficiency required in Microsoft Office (Excel, Word, PowerPoint), QlikView/Qlik Sense or comparable reporting tools, formulary management applications, request management platforms (ConnectUs, Service Desk, Jira, ServiceNow), and PBM adjudication or configuration systems (e.g., Navi ClaimRx). - Prior experience with data analysis, defect tracking, or root cause analysis within a healthcare environment preferred. - 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 Location : Address Remote Location : Country US

• Drive quality for assigned suppliers, including quality plan implementation • Select suppliers through qualification processes • Own supplier results, drive improvements utilizing supplier scorecards • Own supplier audits, ensuring compliance, and driving improvement plans where needed • Collaborate with internal teams to escalate complex issues