Analyst, Data Exchange - Eligibility

Transformcap; United States; Hybrid; USD 81,000 - 121,000; Full time

Job summary

Judi Health, a health technology company, seeks a data-focused professional to support eligibility data processing and onboarding for new clients. You will engage with external partners to discuss eligibility requirements and formats, acting as a subject matter expert on EDI protocols and data integrity.

The role requires a Bachelor’s degree and 1+ year of related experience in PBM/healthcare data exchange.

Qualifications

• Bachelor’s degree is required.
• 1+ year of experience, preferably in PBM/Healthcare/Data Exchange.
• Ability to map PBM concepts and data fields across systems.
• Ability to analyze complex business problems and identify root causes.
• Proficiency in SQL, Excel, JSON; other data skills are a plus.
• Strong communication and stakeholder relationship skills.
• Self-motivated, detail-oriented, able to manage multiple priorities.

Responsibilities

• Attend new client implementation meetings to discuss eligibility requirements and protocols.
• Recommend eligibility file formats and coordinate receipt and processing of data.
• Serve as healthcare data SME on Eligibility and EDI protocols.
• Coordinate eligibility issue identification and resolution with internal/external teams.
• Identify and triage eligibility issues and support data transfer and management.
• Monitor system status and eligibility data to catch abnormalities.

Skills

SQL

Excel

JSON

Data analysis

Communication

Problem solving

Team collaboration

Education

Bachelor’s degree

Job description

About Judi Health

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 Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single,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 solverAbility to handle multiple competing priorities in a dynamic environment and collaborate in a team

New York, NY Salary Range

$96,800 — $121,000 USD

Denver, CO Salary Range

$88,000 — $111,000 USD

Charlotte, NC Salary Range

$80,800 — $101,000 USD

All employees are responsible for adherence to the Judi Health Code of Conduct including the reporting of non-compliance.

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.