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Posted: 10/21/2026Analyst, Tech Operations – Government Programs
Navitus Health SolutionsPosted 10/21/2026full-timeAppleton • Wisconsin • United StatesJunior💰 $43,780 - $52,119 per yearWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in executing Government Programs processes in compliance with CMS regulations, managing Employer Group Waiver Plan (EGWP) enrollment, and ensuring accurate documentation and reconciliation of claims. Strong communication skills are essential for collaborating with various stakeholders, including clients and State/Federal Agencies.
Highest-signal resume keywords
Government Programs ComplianceEmployer Group Waiver Plan (EGWP) ManagementClaims Adjudication ExperienceProcess Documentation MaintenanceStakeholder Communication
About the role
Key responsibilities & impact- Execute Government Programs processes accurately, efficiently, and in compliance with CMS regulations
- Administer and oversee Employer Group Waiver Plan (EGWP) enrollment, retro-eligibility, Financial Information Reporting (FIR), Plan Finder Submission, Coordination of Benefits (COB), reject management, PDE error management and reconciliation, Medicaid Encounter Data, ACA Claims Submission, Explanation of Benefits (EOB), Retiree Drug Subsidy (RDS), and claim auditing
- Oversee assigned process schedules, adjust schedules as necessary, ensure deadlines are met, and alert management when schedules are at risk
- Maintain accurate process documentation and update it when necessary
- Assist subject matter experts in defining and documenting process steps and provide input on technical specification requirements
- Review and research errors and prioritize reconciliation efforts according to State and Federal guidance
- Communicate with Employer Groups, clients, State/Federal Agencies, external vendors, and internal departments to resolve issues and manage expectations
- Work outside normal business hours as needed for time-sensitive processes
- Perform other duties as assigned
Requirements
What you’ll need- Bachelor/Associate Degree in business related field; or equivalent of an associate degree and 2 years of work experience, or 4 years of work experience and a high school diploma or equivalent
- 1+ years’ work experience
- Experience in pharmaceutical claims adjudication systems, retail pharmacy, or in a health plan organization is preferred
- Participate in, adhere to, and support compliance program objectives
- The ability to consistently interact cooperatively and respectfully with other employees
Benefits
Comp & perks- 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%
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims AdjudicationFinancial Information Reporting (FIR)Coordination of Benefits (COB)Medicaid Encounter DataACA Claims SubmissionRetiree Drug Subsidy (RDS)Claim AuditingError ManagementProcess SchedulingReconciliation
Soft Skills
Cooperative InteractionRespectful Communication
Industry Keywords
CMS RegulationsPharmaceutical ClaimsHealth Plan OrganizationEmployer GroupsState/Federal Agencies