Government Programs, Senior Business Analyst

Capital Rx Inc.; New York (NY); Hybrid; USD 111,000 - 139,000; Full time

Job summary

Judi Health seeks a Senior Business Analyst to gather and document business and reporting requirements aligned with state and federal guidelines. You will analyze complex problems, produce specification documents, and support QA and validation activities across government operations.

You will collaborate with compliance, product, sales, marketing, underwriting, implementation, client services, and clinical operations to design, refine, validate, automate, and maintain operational capabilities.

Qualifications

• Bachelor's degree or equivalent required.
• 3+ years of healthcare data experience.
• 3+ years of business process analysis, preferably in healthcare.
• 3+ years of experience with Government Exchange programs.
• Demonstrable knowledge of SQL, Excel, and flow-charting tools.
• Experience with implementation/project management.
• Experience working with cross-functional teams.
• Strong communication and organizational skills.

Responsibilities

• Monitors for changes in existing business processes and updates documentation accordingly.
• Finds new opportunities for process developments and improvements.
• Intake, analyze, document, and manage requests and requirements from stakeholders.
• Proactively reviews business processes to develop SME for processes.
• Drives root-cause-analysis and resolution of data and process issues with stakeholders.
• Designs, documents, and maintains process specifications for cross-functional teams.
• Analyzes workflows and system needs to support regulatory requirements.
• Prepares end-user documentation, requirements docs, and training materials.
• Develops and tests scenarios, validating results against requirements.
• Collaborates with IT, operations, finance, and project teams to translate requirements into solutions.
• Sets up performance metrics for stakeholder distribution.
• Supports PDE submission process by analyzing data issues from multiple sources.
• Improves PDE and encounter submission processes by consolidating recourses into requirements.
• Drives continuous improvement in pharmacy claims reversal and reprocessing workflows.

Skills

SQL

Excel

Flow-charting

Cross-functional teams

Communication

Attention to detail

Agile

Project management

Education

Bachelor's degree or equivalent

Bachelor's degree in Business Administration, Data Analytics, Computer Science or 3+ years of relevant experience

Tools

SQL

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.

Hybrid (Local to New York, NY, Denver, CO or Charlotte, NC)

Position Summary:

The Senior Business Analyst supports the gathering and documentation of business and reporting requirements that align with state and federal guidelines. This individual analyzes complex problems and issues using available information from both internal and external sources. Other responsibilities include creating specification documents for business processes, reports, data extracts, and analyses based on business needs, as well as supporting quality assurance and validation activities. The Senior Business Analyst identifies and interprets trends in datasets to find possible outliers or patterns that can be used to drive process improvements and collaborates with internal and external cross-functional teams (compliance, product, sales, marketing, underwriting, implementation, client services, and clinical operations) to design, refine, validate, automate, and maintain operational capabilities.

Position Responsibilities:

• Monitors for changes in existing business processes and updates documentation accordingly - Finds new opportunities for process developments and improvements
• Finds new opportunities for process developments and improvements
• Intake, analyze, document, and manage requests and requirements from stakeholders
• Proactively reviews business processes and data to develop subject matter expertise of processes supported by our team
• Drives root-cause-analysis and resolution of data and and processes issues/errors by partnering with key stakeholders
• Drives departmental efficiency by designing, documenting, and maintaining comprehensive process specifications for cross-functional teams within the government operations department.
• Analyzes business workflows and system needs to support operational process development, conversions, migrations, and regulatory requirements
• Prepares and maintains end-user documentation, requirements documentation, and training materials as needed
• Develop and test scenarios, validating results based on documented business and functional requirements, and tracking identified issues through resolution
• Partner with stakeholders from business units, IT, operations, finance, and project teams to gather, document, and translate business requirements into actionable solutions for quality assurance and validation
• Develop and set up performance metrics for stakeholder distribution
• Support encounter and PDE (Prescription Drug Events) submission process by analyzing complex data issues using data from internal and external sources
• Improve encounter and PDE submission processes by reviewing and synthesizing state and federal recourses, consolidating into comprehensive business requirements documents
• Recommend and drive continuous improvement initiatives across pharmacy claims reversal and reprocessing. Optimize organization-wide service delivery by auditing and refining workflows, business requirements, standard operating procedures (SOPs), internal controls, and quality assurance activities.
• Performs root-cause analysis of pharmacy claims reversal and reprocessing (R&R) issues; documents findings, develops recommendations, and supports issue resolution based on data and industry knowledge

Required Qualifications:

• Bachelor's degree or equivalent
• 3+ years of healthcare data experience
• 3+ years of business process analysis, preferably in healthcare
• 3+ years of experience with Government Exchange programs
• Demonstrable knowledge of SQL, Excel, and flow-charting tools
• Experience with implementation/project management
• Experience working with cross-functional teams
• Extremely flexible, highly organized, excellent communication and able to shift priorities easily
• Attention to detail & commitment to delivering high-quality work product
• Comfort or experience in a fast-paced, growing environment
• Intellectual and professional curiosity
• Familiarity with the agile framework/Certified Scrum Product Owner preferred
• Bachelor's degree in Business Administration, Data Analytics, Computer Science or 3+ years of relevant experience

• New York, NY Salary Range: $110,800 — $138,500 USD
• Denver, CO Salary Range: $101,600 — $127,000 USD
• Charlotte, NC Salary Range: $92,400 — $115,500 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.