Data Exchange Manager - Claims Operations

Capital Rx; Denver (CO); Hybrid; USD 138,000 - 172,500; Full time

Job summary

Judi Health in Denver is seeking a Data Exchange Manager to lead day-to-day data exchange operations across PBM and TPA lines, overseeing analytics, onboarding, EDI, eligibility feeds, claims exchanges, and QA. The role partners with internal teams and external partners to design, maintain, and troubleshoot data exchange processes supporting claims, formulary, network, and eligibility.

Strong PBM/TPA data expertise, analytical skills, and clear communication are required to align Judi Health

Qualifications

• Bachelor's degree or equivalent experience.
• 5+ years in healthcare data exchange, EDI, PBM or claims administration.
• Leadership experience within PBM or healthcare setting.
• Knowledge of PBM and TPA data structures and healthcare EDI standards.
• Proficiency in SQL, Excel, and other analytical tools.
• Exceptional analytical and communication skills.

Responsibilities

• Lead and develop Data Exchange staff across PBM and TPA operations.
• Oversee connectivity setup and configuration for new and existing clients.
• Manage PBM integrations including eligibility, claims, accumulators, formulary and network data.
• Oversee TPA EDI transactions such as 834, 837, 835, 270/271, 276/277, 278.
• Ensure data quality, reconciliation, audits and issue resolution.
• Partner with Implementations, Client Services, Product, Engineering and external partners.
• Drive automation, process improvement and operational excellence.
• Ensure HIPAA and regulatory compliance.

Skills

Healthcare data exchange

Leadership

SQL

Excel

Communication

Analytical thinking

Project management

Education

Bachelor's degree or equivalent experience

Tools

SQL

Excel

Job description

About Judi Health

Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including:

• Judi Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers,
• Judi Health, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and
• Judi, the industry's leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform.

Together with our clients, we're rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit www.judi.health.

Location:

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

Position Summary:

The Data Exchange Manager is responsible for leading day-to-day Data Exchange operations supporting both PBM and TPA (Medical, Dental and Vision) business lines. The role oversees analysts and specialists responsible for healthcare data integrations, client onboarding, EDI transactions, eligibility feeds, claims exchanges, configuration setup, data quality monitoring, and operational issue resolution.

Manager will works closely with internal teams and external partners to design, maintain, and troubleshoot data exchange processes that support claims, formulary, network, and eligibility operations. Success in this role requires deep PBM and TPA data expertise, strong analytical and problemsolving abilities, and the communication skills needed to drive alignment across JUDI Health and with our clients.

Position Responsibilities:

Data Feed & Integration Management

• Lead and develop Data Exchange staff across PBM and TPA operations.Oversee connectivity setup and configuration activities for all new and existing clients.
• Oversee healthcare data exchange operations, connectivity, onboarding and production support.
• Manage PBM integrations including eligibility, claims, accumulator, formulary and network data.
• Oversee TPA EDI transactions including 834, 837, 835, 270/271, 276/277 and 278.
• Ensure data quality, reconciliation, audits and issue resolution.
• Partner with Implementations, Client Services, Product, Engineering and external trading partners.
• Drive automation, process improvement and operational excellence.
• Ensure HIPAA and regulatory compliance.

Issue Resolution & Operational Excellence

• Serve as a central coordination point for issue identification, triage, and resolution across internal teams and external integration partners.
• Monitor system status, data movement, and platform dashboards to proactively detect abnormalities impacting quality or performance.
• Ensure all data exchange issues are remediated according to established SLAs, operating standards, and audit controls.
• Perform and oversee audits and reconciliation processes to validate data integrity across systems.

CrossFunctional & External Collaboration

• Partner with Implementation, Operations, Client Success, Product, and Engineering to support client onboarding, migrations, vendor changes, and enhancement requests.
• Act as a liaison across business areas to ensure alignment, clear communication, and coordinated prioritization.
• Translate business requests into technical requirements, assess complexity, and support accurate effort estimation and SLA assignment.

Process Improvement & Documentation

• Identify opportunities to streamline workflows, enhance data quality, and reduce operational risk through automation and process refinements.
• Develop and maintain comprehensive documentation-including policies, procedures, and configuration standards for JUDI system operations.

Compliance & Regulatory Awareness

• Stay current with Medicare, Medicaid, and state regulatory requirements to ensure all data exchange processes remain compliant.
• Follow and reinforce the JUDI Health Code of Conduct, including escalation and reporting of noncompliance when appropriate.

Required Qualifications:

• Bachelor's degree or equivalent experience.
• 5+ years in healthcare data exchange, EDI, PBM or claims administration.
• Leadership experience within a PBM or healthcare setting, preferably managing highvolume data exchange or interoperability functions.
• Knowledge of PBM and TPA data structures and healthcare EDI standards.
• Proficiency in SQL, Excel, and other analytical tools preferred.
• Exceptional analytical skills with the ability to diagnose root causes and propose effective solutions.
• Strong communication skills with the ability to build and maintain relationships across technical and nontechnical stakeholders.
• Highly organized, selfmotivated, and able to manage multiple priorities in a fastpaced environment.

New York, NY Salary Range: $150,800 — $188,500 USD

Denver, CO Salary Range: $138,000 — $172,500 USD

Charlotte, NC Salary Range: $125,600 — $157,000 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.