Benefits Configuration & QA Specialist

Capital Rx; New York (NY); Hybrid; USD 95,000 - 100,000; Full time

Job summary

Judi Health is seeking a Benefit Operations Specialist to lead benefit configuration, tests, and QA for medical and pharmacy programs. You will coordinate cross-functional work with product/dev and stakeholder teams to tailor client requests and ensure accurate benefit design.

This role supports government expansions and required regulatory compliance. Ideal candidates have 3+ years in TPA/health plan environments, strong communication, and experience with Agile methods.

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

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

Skills

Attention to detail

Communication skills

Agile experience

Cross-functional collaboration

Education

Bachelor's degree preferred

Tools

SQL

Excel

Data visualization tools

Job description

Judi Health is seeking a Benefit Operations Specialist to lead benefit configuration, tests, and QA for medical and pharmacy programs. You will coordinate cross-functional work with product/dev and stakeholder teams to tailor client requests and ensure accurate benefit design.

This role supports government expansions and required regulatory compliance. Ideal candidates have 3+ years in TPA/health plan environments, strong communication, and experience with Agile methods.