Analyst, Data Exchange - Eligibility

Capital Rx; Denver (CO); Hybrid; USD 88,000 - 111,000; Full time

Job summary

Judi Health seeks a qualified specialist to coordinate eligibility data across PBM systems, discuss formats with external partners, and ensure accurate data transfers. You will act as a healthcare data SME on eligibility guidelines and EDI protocols, resolving data issues and supporting audits to maintain data integrity.

The role is hybrid with offices in NYC, Denver, and Charlotte, providing opportunities to contribute to client implementations and maintain compliance while collaborating across

Qualifications

• Bachelor's degree required.
• 1+ years of experience in PBM, healthcare, data exchange, or eligibility.
• Ability to map PBM concepts and data fields across systems for consistent data transfers.
• Proficient in SQL, Excel, and JSON.
• Strong communication and collaboration skills.

Responsibilities

• Attend client implementation meetings with external partners to discuss eligibility requirements and protocols.
• Recommend eligibility file formats and coordinate receipt and processing of eligibility data.
• Act as a healthcare data SME on eligibility guidelines and EDI protocols.
• Coordinate eligibility issue identification and resolution with internal teams and external partners.
• Identify and triage eligibility issues; support resolution of data transfer errors.
• Monitor system status and eligibility data to identify anomalies affecting quality.
• Ensure issues are resolved following operating standards and SLAs.
• Assist with validation of eligibility data integrity through audits and reconciliations.
• Ensure accurate entry of group/plan structure determinations for benefits and enrollment.

Skills

SQL

Excel

JSON

Data analysis

Communication

Education

Bachelor's degree

Job description

Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels. At Judi Health, we're deploying the infrastructure our country needs to deliver the healthcare we all deserve. We are the intelligence platform powering benefits plans for millions of Americans and proudly leading the next generation of care. To learn more, visit www.judi.health.

Location

Hybrid 3 days (offices in NYC, Denver, CO and Charlotte, NC area)

Position Responsibilities

• Attend new client implementation meetings with external partners to discuss eligibility requirements and protocols
• Recommend eligibility file formats to external partners and coordinate receipt and processing of eligibility data
• Acting as a healthcare data subject matter expert on Eligibility guidelines and Electronic Data Interchange (EDI) protocols
• Serving as a point of coordination for member eligibility issue identification and issue resolution with internal teams and external partners
• Identify and triage eligibility issues and support the resolution of all errors related to transferring, loading, and management of eligibility data
• Proactively monitoring system status and eligibility data to quickly identify potential abnormalities that might impact quality and accuracy
• Ensuring that all issues and errors are resolved using designated operating standards and within defined service levels
• Assist with the validation of eligibility data integrity through regular audits and reconciliation processes
• Ensure accurate and timely entry of group/plan structure determinations for benefits and enrollment
• All employees are responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance.

Required Qualifications

• Bachelor's degree
• 1+ years of previous work experience, preferably in PBM, Healthcare, Data Exchange, and Eligibility
• Ability to match key PBM concepts and data fields across various systems and file layouts to ensure consistency and accuracy of data transfers
• Ability to analyze complex business problems to discover and resolve root causes
• Proficiency in SQL, Excel, JSON and other technical data skills preferred
• Strong communication skills with the ability to develop effective work relationships with internal and external stakeholders
• Self-motivated and detail-oriented problem solver
• Ability to handle multiple competing priorities in a dynamic environment and collaborate in a team

Salary

New York, NY: $96,800 - $121,000 USD

Denver, CO: $88,000 - $111,000 USD

Charlotte, NC: $80,800 - $101,000 USD

All employees are responsible for adherence to the Judi Health Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.

We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at https://www.judi.health/legal/privacy-policy.