Navitus Health Solutions, LLC logo
Navitus Health Solutions, LLC

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.

Product Manager, Claim Adjudication (GP)

Product ManagerProduct ManagerFull TimeRemoteLeadTeam 1,001-5,000

Location

United States

Posted

85 days ago

Salary

$82.6K - $101K / year

Seniority

Lead

No structured requirement data.

Job Description

Product Manager, Claim Adjudication (GP)

Navitus Health Solutions, LLC

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. ____________________________________________________We are committed to providing equal employment opportunity to all applicants and employees and comply with all applicable nondiscrimination regulations, including those related to protected veterans and individuals with disabilities. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or handicap. Pay Range USD $82,586.00 - USD $101,333.00 /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 Adjudication Product Manager (CAPM) to our team. The Claims Adjudication Product Manager (CAPM) is responsible for ensuring Med D, Medicaid, and Exchange claims are adjudicating per CMS regulations as well as specific client needs. The CAPM will collaborate with other Navitus teams to ensure that the appropriate software, procedures, and oversight monitoring are implemented and operational in support of an environment of continuous improvements with claims adjudication. Is this you? Find out more below! Responsibilities How do I make an impact on my team? - Champion and maintain a proactive internal audit process to verify claims are adjudicating as expected. Conduct root cause analysis to minimize future defects - When adjudication issues are discovered, champion root cause analysis efforts of these issues in support of continually lowering our adjudication Defects per Million opportunities - Work closely with Recoveries Product Manager to verify recoveries projects produce the expected results as well as to improve the overall accuracy of the adjudication process - Oversee all adjudication-related fixes/enhancements. This includes oversight of system requirements development, and testing - Ensure post-implementation monitoring processes are in place to validate adjudication-related fixes/enhancements are working as expected - Serve as subject matter expert for claims adjudication-related questions and system enhancements - Oversee timely completion of Acumen audit responses and leverage these results to improve claim adjudication accuracy - Ensure metrics are monitored and reported - Create and maintain claim adjudication training resources - Other duties as assigned Qualifications What our team expects from you? - College degree or equivalent experience required in managed care or health insurance - Minimum of two years’ experience with Medicare claims adjudication preferred - Has successfully lead root cause analysis projects - Project Management and/or Business Analyst experience a plus - Data analysis experience a plus - On-call availability - Some travel may be required - 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

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Director, Securites-Based Lending (Wealth)

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Product Manager85 days ago
Full TimeRemoteTeam 10,001

Application Deadline: 05/30/2026 Address: VIRTUAL(R)13 - HomeRes - IL Job Family Group: Wealth Sales & Service Job Profile Summary The Director, Secured Business Lending (SBL) is accountable for the end‑to‑end product strategy, governance, risk oversight, and financial performance of the SBL portfolio across Wealth and Private Banking. This role serves as the enterprise owner of the SBL product, with responsibility for product design, pricing, portfolio health, operational controls, regulatory compliance, and margin risk management. The role operates at an enterprise and regulatory-facing level, acting as a trusted advisor to senior leadership and regulators, and ensuring the SBL platform is scalable, resilient, and aligned with the Bank’s risk appetite and growth strategy. 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Comcast logo

Group Product Manager, Universal Ads

Comcast

Headquartered in Philadelphia, Pennsylvania, Comcast was established in 1963 as a single-system cable company. Over the years, Comcast experienced tremendous gr

Product Manager85 days ago
Full TimeRemoteTeam 10,000Since 1963

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Job Closed
DraftKings Inc. logo

Product Manager II

DraftKings Inc.

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Product Manager85 days ago
Full TimeRemoteTeam 1,001-5,000

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Canada
Job Closed
Origin Bank logo

Settlement Analyst

Origin Bank

Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.

Product Manager85 days ago
Full TimeRemoteTeam 501-1,000Since 1912H1B Sponsor

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Job Description Settlement Analyst processes incoming wires and settlements as their priority; assists with funding duties as needed.Word Duties and Responsibilities include the following: - Processes receipt and settlement of incoming wires from investors and return wires from closing agents; follows up with clients for missing Purchase Advises or wire discrepancies; notifies Treasury Desk of any incoming wires >$5MM. - Works with FHLB, Wire Desk, IT, Accounting and Treasury as needed to resolve issues. - Helps maintain department Settlement procedures. - Responds timely with research and resolution of GL outages reported by Accounting. - Receives, reviews and performs quality review on loans submitted by clients for funding, in accordance with Origin Bank and Warehouse Lending policies and procedures. - Authorizes loans to go forward for funding approval based on criteria provided, or escalates all questionable findings, issues or exception requests to management. - Helps maintain department Funding procedures. - Processes additional wires per client request. - Processes transfer of funds from Client DDA accounts to process Originator Participations and additional wires/manual advances. - Performs pre- and post-funding quality control reviews in accordance with Warehouse Lending policies and procedures. - Processes originator payoffs and curtailments as requested. - Monitors Bot processing of daily posting of Originator Participations and settlement residual funds to Client DDA accounts; emails Participation Statement to Participating Banks when completed. - Adds/updates WLS User information & provides installation instructions for clients; Updates Master Client List; Resets passwords per client request. - Verifies settlement agent wire instructions/CPL/insurance coverage and sets up new agents in WLS. - Responds timely to Wire Desk requests and OFAC verifications. - Monitors expiration dates for Client E&O/Fidelity Bond and State Licenses; Obtains current policies from clients and updates WLS as required. - Processes internal “swings” from one warehouse line to another for client-to-client purchases, OTC modifications, and sublimit moves; notifies team to update collateral status. - Runs Daily Disbursement report/checks Fed Ref #'s/sends 'Done for the Day' email to Warehouse Lending, Wire Desk & Mortgage Accounting. - Responds timely to client emails concerning information requests, quality control documentation, return wires, funding cancellations, updates, wire confirmations, etc. - If responsible, may board new clients in WLS, add business rules, add users, link to products, closing agents & investors; distribute login credentials. - If responsible, may update client info due to renewals, extensions, amendments, bulges, exception approvals - If responsible, processes monthly interest payments for OTC, IML sublimit loans. - If responsible, processes all OTC funding and draws in the absence of the Mortgage One Time Closing Manager, or to assist with heavy volume. - Cross-trains with the Shipping team or other areas where the Warehouse Lending Operations Manager sees the opportunity for continuing training or support. - Trains new Warehouse Lending employees and new Clients as needed. - Attends industry events, representing Origin Bank Warehouse Lending Department in a professional manner. 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Organizational Support - Follows policies and procedures; Supports organization's goals and values. Planning/Organizing - Prioritizes and plans work activities; Uses time efficiently. Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments. Quality and Quantity - Demonstrates accuracy and thoroughness; Applies feedback to improve performance; Completes work in timely manner; Works quickly. Attendance/Punctuality and Dependability - Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time; Follows instructions, responds to management direction; Commits to long hours of work when necessary to reach goals. Adaptability, Initiative and Innovation - Able to deal with frequent change, delays, or unexpected events; Asks for and offers help when needed. Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education and/or Experience Associate's degree (A. A.) or equivalent from two-year college or technical school; minimum five years related experience and/or training in mortgage banking with warehouse lending, closing/funding and mortgage shipping; or equivalent combination of education and experience. Computer Skills To perform this job successfully, an individual should preferably have knowledge of FIS eWire; IBS Insight; WLS (Warehouse Lending System) software, Microsoft Word, Excel and Outlook. Bank Culture/Customer Service Skills Promotes the Bank’s culture, including the support of our Brand promise and Core Values. Ability and judgment to interact and communicate appropriately with other employees, customers and supervisor. Ability to serve customers, both internal and external, (community/public) in a manner that will reflect superior customer relations and enhance the overall marketing effort of Origin. Other Skills and Abilities Must be able to read and understand mortgage documents such as Form 1003, Closing Disclosure, property appraisals, investor locks and purchase commitments, property deeds and mortgage notes. Physical Demands While performing the duties of this Job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms and talk or hear. The employee is frequently required to stand and walk. The employee is occasionally required to climb or balance and stoop, kneel, crouch, or crawl. The employee must regularly lift and /or move up to 10 pounds, frequently lift and/or move up to 25 pounds and occasionally lift and/or move up to 50 pounds. Specific vision abilities required by this job include close vision, color vision and ability to adjust focus. Work Environment/Telecommuting This is a fully remote position, and the individual must follow the Bank’s policies in this regard. When/if working in the office, the work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. This job description reflects management's assignment of essential functions. It does not prescribe or restrict the tasks that may be assigned. Origin Bank shall, in its discretion, modify or adjust the position to meet the Bank’s changing needs. This job description is not a contract and may be adjusted as deemed appropriate in the Bank’s sole discretion. Word Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws. Know Your Rights

United States
Job Closed