Benefit Operations Specialist

Judi Health; Charlotte, Denver, New York (NC, CO, NY); On-site; USD 80,000 - 85,000; Full time

Job summary

Judi Health is seeking a Benefit Operations Specialist to lead benefit configuration, claims testing, and QA across client implementations. You will help deliver integrated medical and pharmacy benefit programs and influence operational best practices within a fast-moving health tech space.

The role involves configuring new plans, performing tests and audits, and coordinating with product/dev teams to meet client needs, including government program expansions, while maintaining quality and SLA

Qualifications

• 3+ years of TPA / health plan experience in medical benefit configuration, testing, or related areas.
• Experience with Cigna or Aetna preferred.
• Pharmacy, Dental, or Vision experience a plus.
• Self-funded plans, Medicare/government programs and ERISA experience preferred.

Responsibilities

• Configure, set up new plans and changes, run claims testing and audits.
• Collaborate across product/dev and stakeholder teams to tailor configurations for clients.
• Explain testing processes and test claims to non-experts clearly.

Skills

TPA experience

Agile methodology

Communication skills

SQL / data viz

Tools

Excel

SQL

Data viz tools

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 Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single,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.

Location: 3-days Hybrid (Local to NYC , Denver , or Charlotte )

Position Summary

Join our first-of-its-kind Integrated Benefits team as a Benefit Operations Specialist, where you will play a pivotal role in delivering comprehensive medical and pharmacy benefit programs for Judi Health clients. You will lead benefit configuration, claims testing, and quality assurance processes, ensuring accuracy and efficiency across all implementations. This position offers the opportunity to influence operational best practices and contribute to a team that is redefining how integrated benefits are delivered in the healthcare space.

Position Responsibilities

• Responsible for all aspects of benefit configuration, including new plan setup, plan change setup, claims testing, and regular audits
• Drives cross-functional collaboration with the product/dev team as well as additional stakeholder teams to ensure client customized requests are configurable for both new plan setups and plan changes
• Clearly communicate benefit configuration setup and testing process or specific test claims to clients in a concise way that can be understood by users who are not experts in benefit areas
• Make recommendations to streamline the work processes and systems that impact plan/benefit design to create efficiency and quality outcomes
• Works cross-functionally to create new benefit options aligning with market needs, including expansion in government programs
• Develop standards and custom batch testing scenarios and inputs, reviewing test claims output to validate claim accuracy against the clients’ benefit design
• Develops standard policy and procedures, training materials and provide education for training and presentation to cross-functional teams
• Maintain acceptable and appropriate quality levels and production SLA response time
• Participate in client meetings to assess new client benefit information or change requests to ensure design of Judi logic ties to the benefit configuration intended to meet client needs
• Partner with leadership to develop benefit plan designs and ensure that the plan designs meet client requests, Health Plan strategic/business parameters, and all regulatory and other oversight agencies’ requirements
• Partner with Client Services team as clients go live and troubleshoot benefit-related discrepancies, errors, and problems
• Support general business or team needs, as assigned

Qualifications

• 3+ years of TPA / health plan experience in Medical Benefit configuration, benefit testing, claims monitoring, SPD creation, Medical Coding or other applicable department needs
• Experience with Cigna or Aetna preferred
• Pharmacy, Dental, or Vision experience a plus
• Self-funded plans, Medicare/Government programs and ERISA experience preferred
• Tremendous attention to detail, ability to shift priorities easily and ability to work in high paced, deadline drive environment.
• Exceptional written and verbal communication skills
• Experience working with product/dev teams and familiarity with Agile, preferred
• Preferred: experience working with structured or unstructured data in Excel, SQL, and other data visualization tools

New York, NY Salary Range

$95,000 - $100,000 USD

Denver, CO Salary Range

$85,000 - $90,000 USD

Charlotte, NC Salary Range

$80,000 - $85,000 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 athttps://www.judi.health/legal/privacy-policy .