Government Programs Operations Lead - Remote

Capital Rx; United States; Hybrid; USD 115,000 - 160,000; Full time

Job summary

Judi Health seeks a Senior Manager, Government Programs Operations to drive regulatory compliance and operational excellence for Exchange programs. You will lead reporting, audits, and cross-functional initiatives with Legal, Compliance, and Product teams to ensure adherence to CMS and state guidance, delivering scalable, compliant processes.

The role emphasizes translating regulatory requirements into actionable business and system changes, with a focus on data-driven insights and performance

Qualifications

• 6+ years of Prescription Benefit Management/Health Plan experience supporting Exchange programs.
• 5+ years people management experience.
• Subject matter expertise of Exchange regulatory requirements and related product/operational workflows.
• Experience supporting regulatory reporting, audits, and compliance activities.
• Ability to translate regulatory guidance into business and system requirements.

Responsibilities

• Lead Government Programs support for Exchange operations (claims adjudication, regulatory reporting, audit support).
• Oversee day-to-day operational performance for Exchange programs aligning with contractual/regulatory requirements.
• Interpret and monitor federal/state regulatory requirements impacting Exchange lines of business.
• Collaborate with SMEs across Claims, Product, Technology, Compliance, Legal to implement changes.
• Design, document, and scale processes for compliant, efficient service delivery.
• Define business and system requirements to support compliant claims processing and reporting.

Skills

Regulatory compliance

Regulatory reporting

Audits

Cross-functional leadership

Guidance translation

Data-driven decisions

Program management

Healthcare exchange

Stakeholder management

Job description

Judi Health seeks a Senior Manager, Government Programs Operations to drive regulatory compliance and operational excellence for Exchange programs. You will lead reporting, audits, and cross-functional initiatives with Legal, Compliance, and Product teams to ensure adherence to CMS and state guidance, delivering scalable, compliant processes.

The role emphasizes translating regulatory requirements into actionable business and system changes, with a focus on data-driven insights and performance