Health Plan Account Manager: PBM & Medicare

Judi Health, LLC; New York (NY); Hybrid; USD 84,000 - 126,000; Full time

Job summary

Judi Health, LLC is seeking an Account Manager focused on PBM and Medicare to deliver seamless client experiences, manage benefit changes, implement new plans, and ensure pricing accuracy across multiple markets. You will lead QA initiatives, identify claim discrepancies, and collaborate across teams to streamline processes, ultimately improving client satisfaction and operational efficiency.

The role involves cross-functional collaboration, data-driven decision making, and ongoing relationship

Qualifications

• Undergraduate bachelor’s degree, with record of strong academic performance
• 5+ years of proven experience in PBM / health plan, benefits consulting, healthcare
• Track record of building trusting internal and external relationships
• Track record of leading cross-functional initiatives, driving high performance, meeting deadlines, and executing on deliverables
• Experience working with structured and unstructured data
• Proficient in Microsoft Office, SQL a bonus
• Ability to balance multiple complex projects simultaneously
• Exceptional written and verbal communication skills
• Extremely flexible, highly organized, and able to shift priorities easily

Responsibilities

• Partner with clinical account manager (CAM) and account executive (AE) to manage clients through the entire lifecycle from implementation through go-live and renewal on a designated book of business
• Support implementation as a critical member of the client management teams with all day-to-day client requirements
• Responsible for timely and accurate management and execution of all client benefit requests, including benefit changes, eligibility changes, override requests, demos and new implementations
• Analyze incoming client requests and work with internal and external teams to complete required plan documentation
• Support implementation of new plans, pricing, and networks, consistent with strategic or administrative intent
• Lead pre- and post-implementation quality assurance and testing to validate coding accuracy
• Lead claim reviews to proactively identify discrepancies or inaccuracies and develop solutions to address
• Travel requirements not to exceed 25%
• Handle and resolve sponsor and member issues, escalating as needed
• Research and respond to claims processing and system configuration inquiries
• Coordinate integration of other data inputs into client management processes
• Collaborate cross functionally to support general client operations, as required
• Responsible for relationship management and contribution to successful NPS and Account Management Survey results, along with retention support

Skills

PBM/health plan

Relationship building

Cross-functional leadership

Data handling

Microsoft Office

SQL

Communication

Multitasking

Education

Bachelor's degree

Tools

Microsoft Office

SQL

Job description

Judi Health, LLC is seeking an Account Manager focused on PBM and Medicare to deliver seamless client experiences, manage benefit changes, implement new plans, and ensure pricing accuracy across multiple markets. You will lead QA initiatives, identify claim discrepancies, and collaborate across teams to streamline processes, ultimately improving client satisfaction and operational efficiency.

The role involves cross-functional collaboration, data-driven decision making, and ongoing relationship