Hybrid Government Programs Ops Analyst — R&R, Medicare/Medicaid

Judi Health, LLC; Charlotte (NC); Hybrid; USD 82,000 - 103,000; Full time

Job summary

Judi Health is seeking a Government Programs Operations Analyst to support Medicare, Medicaid, Exchange, and Commercial lines. You will serve as the Reprocessing & Reversals SME, executing R&R activities, providing regulatory guidance, and coordinating with Product and Development to design, test, and implement system enhancements.

Responsibilities include testing, documentation, and ensuring compliant, scalable operations across CMS guidelines.

Qualifications

• 3+ years of experience in PBM or health plan operations.
• Subject matter expert in pharmacy claim reprocessing and reversals.
• Advanced MS Excel skills; familiarity with SQL is a plus.
• Experience partnering with cross-functional teams to define requirements and test solutions.
• Strong analytical and problem-solving skills; regulatory reporting impacts.

Responsibilities

• Serve as the primary R&R SME, executing activities and supporting process improvement across lines of business.
• Run and validate R&R activities including complex claim reversals and reprocessing.
• Define R&R business requirements with Product/Development and oversee implementation.
• Perform operational testing, document outcomes, and coordinate post-production monitoring.
• Maintain R&R procedures, controls, and audit-ready evidence.

Skills

PBM operations

Excel (advanced)

SQL

Cross-functional collaboration

CMS compliance

Tools

Excel

SQL

Job description

Judi Health is seeking a Government Programs Operations Analyst to support Medicare, Medicaid, Exchange, and Commercial lines. You will serve as the Reprocessing & Reversals SME, executing R&R activities, providing regulatory guidance, and coordinating with Product and Development to design, test, and implement system enhancements.

Responsibilities include testing, documentation, and ensuring compliant, scalable operations across CMS guidelines.