Benefit Operations Specialist

Capital Rx; Denver (CO); Hybrid; USD 85,000 - 90,000; Full time

Job summary

Judi Health is seeking a Benefit Operations Specialist to configure medical and pharmacy benefits, run claims testing, and ensure QA across implementations. You will work with product/dev teams to tailor plans, communicate complex configurations to clients, and drive process improvements for efficient benefit delivery.

The role offers hybrid work in multiple US locations and opportunities to influence best practices within integrated benefits.

Qualifications

• Bachelor's degree preferred.
• 3+ years of TPA/health plan experience in Medical Benefit configuration, testing, and claims monitoring.
• Experience with Cigna or Aetna preferred.
• Pharmacy, Dental, or Vision experience a plus.
• Self-funded plans, Medicare/Government programs and ERISA experience preferred.
• Attention to detail with ability to manage priorities in a fast-paced environment.
• Excellent written and verbal communication skills.
• Experience working with product/dev teams and familiarity with Agile preferred.
• Proficiency with Excel, SQL, and data visualization tools is a plus.

Responsibilities

• Configure benefits including new plan setup and changes, perform claims testing and audits.
• Collaborate with product/dev and other teams to tailor plans for client requests.
• Explain benefit configuration and testing processes clearly to clients.
• Recommend process improvements to increase efficiency and quality.
• Work cross-functionally to create new benefit options aligned with market needs, including government programs.
• Develop standard testing scenarios and validate test claims against benefit designs.
• Create training materials and provide education for cross-functional teams.
• Maintain SLA performance and quality levels in production.
• Participate in client meetings to align Judi logic with client needs.
• Partner with leadership to design benefit plans meeting regulatory and client requirements.
• Assist Client Services during live deployments and troubleshoot discrepancies.
• Support general business or team needs as assigned.

Skills

TPA experience

Benefit configuration

Claims monitoring

SPD creation

Medical Coding

Cigna/Aetna experience

Pharmacy/Dental/Vision exp

Self-funded/Medicare/ERISA

Attention to detail

Verbal/Written communication

Agile experience

Excel

SQL

Data visualization

Education

Bachelor's degree

Tools

Excel

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

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

• Bachelor's degree preferred
• 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.