Supervisor, Issue Management

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

The Supervisor, Issue Management is responsible for overseeing issue management processes, leading a team of direct reports, and maintaining effective communication with internal and external partners. This role focuses on overseeing claims reprocessing activities, driving proactive risk mitigation, and ensuring clear documentation of business requirements. The ideal candidate will have strong leadership skills, experience in issue management, root cause analysis, preventative action planning, process improvements, and excellent client-facing abilities.

Is this you? Find out more below!

How do I make an impact on my team?

Lead, mentor, develop, and manage a team of direct reports
• Provide guidance and support to team members to ensure high performance and professional growth
• Conduct performance reviews
• Oversee the identification, tracking, and resolution of issues within PBM operations
• Maintain detailed records of issues, root cause analyses, and preventative actions
• Communicate findings and action plans to clients in a clear and professional manner
• Build and maintain strong relationships with clients/client facing teams and address their concerns effectively
• Conduct and oversee root cause analyses (RCA) to identify underlying issues
• Develop and implement preventative action plans to mitigate future issues
• Identify opportunities for process improvements based on issue management findings
• Provide training and support to team members on RCA and preventative action methodologies
• Apply knowledge of claims processing workflows, systems, and procedures, including adjudication, resolution, and documentation standards, to support team operations and ensure accuracy and compliance
• Other duties as assigned

What our team expects from you?

• Bachelor's degree or equivalent work experience is required
• 3+ years of experience required in issue management, root cause analysis, and preventative action planning within the PBM or healthcare industry
• Proven experience in leadership and team management
• Demonstrated knowledge of claims processing workflows, systems, and procedures, including adjudication, resolution, and documentation standards is required
• Experience with RCA tools and methodologies
• Proficiency in Microsoft Office Suite
• Knowledge of regulatory requirements and industry standards in PBM
• 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!

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