Navitus Health Solutions

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Government Programs Customer Care Associate Product Manager

at Navitus Health Solutions

Posted: 10/24/2017
Job Reference #: 5000256317606

Job Description

Requisition Number



Appleton Campus: Appleton, Wisconsin

Other Locations



Minimum Associates degree or minimum 4 years relevant experience required


  • High level knowledge of Customer Care and organizational processes
  • Demonstrated competence in Microsoft Office including PowerPoint, Word, Excel, and Visio
  • Experience developing and executing on improvements
  • Demonstrated excellence in a customer service role
  • Medicare, Medicaid and/or Exchange experience

Job Description

Job Summary:

The Government Programs Customer Care Product Manager (GPCCPM) is responsible for supporting the Medicare Part D, Medicaid and Exchange resources and processes within Customer Care. Collaborating with Customer Care Leadership, the GPCCPM will assist with analyzing, monitoring, and implementing change as necessary to ensure the Customer Care staff consistently meet performance metrics, follow CMS guidelines and deliver superior and compliant service to internal and external customers. The GPCCPM will remain informed of current and anticipated CMS requirements through the exercise of reading and interpreting new and modified regulations. The GPCCPM will create action plans from audit requirements, prepare content for these audits, and present during audits in person or remotely. The GPCCPM will review audit findings and create action plans to eliminate non-compliance events and address any recommendations to improve. The GPCCPM will serve as a Government ProgramsCustomer Care subject matter expert (SME) and will assist and collaborate with all departments and other entities as required to ensure successful performance of the department. The GPCCPM will work closely with training staff to ensure new content is prepared correctly and delivered accurately as well as ensuring retention and application of new information. This role will also interface closely with content management staff to ensure resources utilized by staff are current, accurate, and intuitive.

Job Responsibilities:

  • Develops and maintains deep subject matter expertise related to Medicare Part D, Exchange and Medicaid requirements
  • Works with Customer Care Leadership to monitor, interpret and communicate Medicare, Exchange and Medicaid regulations, guidance, and system changes
  • Assists with the development and maintenance of product documentation and training materials for Customer Care
  • Works closely with Government Programs Program Management to ensure that the appropriate processes and procedures are implemented within Customer Care and cross-functionally between departments
  • Assists with preparation for and execution of CMS audits, Medicaid delegation audits, and other audits as needed
  • Collaborate with the Customer Care content management team to ensure Medicare, Exchange and Medicaid client resources are developed, maintained, and translated appropriately
  • Maintain in-depth knowledge of Navitus' claims processing software and other applications and reporting tools as applicable
  • Create, test and implement enhancements to the claims processing system for increased adherence to government-mandated processes
  • Lead improvements that support client/CMS expectations and ongoing continuous improvements focused on enhancing efficiency and accuracy of department processes
  • Reviews work of Specialists to ensure compliance with specific attention paid to areas of risk like coverage determinations and complaints
  • Outline and execute on processes to proactively monitor department compliance with requirements
  • With Leadership, identify key performance indicators, request and test reports to monitor these indicators, set goals for indicators, and create plans to improve when goals are not met.
  • Travel to client or auditing body sites as requires for audit participation
  • Provide effective communication of Navitus' vision, mission, values, goals and policies
  • Learn and abide by company and departmental policies and procedures while maintaining a professional business environment