Hybrid Pharmacy Pricing Appeals Specialist

Judi Health; Charlotte, Denver, New York (NC, CO, NY); Hybrid; USD 32,000 - 39,000; Full time

Job summary

Judi Health, a health technology company, seeks a Pharmacy Pricing Appeals Analyst to manage end-to-end intake, review, investigation, documentation, and processing of pharmacy pricing appeals. You will validate requests, research PBM and pharmacy claims, review invoices, analyze outcomes, and maintain records with strong attention to detail.

You will work with the Manager, Pharmacy Pricing Appeals and partners in Analytics, Network Operations, Finance, and Compliance to ensure timely, accurate

Qualifications

• Minimum 2 to 4 years of PBM, pharmacy operations, pharmacy claims, pharmacy reimbursement, network operations, or healthcare claims experience
• Associates Degree preferred; equivalent combination of education and pharmacy/PBM experience may be considered
• Direct experience researching, validating, or resolving pharmacy claims
• Experience with claims tracking tools, spreadsheets, and operational documentation
• Working knowledge of pharmacy reimbursement concepts and PBM claims processes
• Intermediate to advanced Excel skills, including data entry, filtering, sorting, and templates

Responsibilities

• Claims Investigation – research pharmacy claim details, validate identifiers and document findings
• Analytical Thinking – compare pharmacy claim payment data against invoices and acquisition cost
• Pharmacy Claims Knowledge – understand PBM and pharmacy claims terminology, adjudication, and reimbursement concepts
• Communication – clear written and verbal communication with internal stakeholders and pharmacy contacts
• Data Integrity – ensure accurate, complete and audit-ready records

Skills

PBM experience

Pharmacy operations

Pharmacy claims

Pharmacy reimbursement

Network operations

Healthcare claims

Excel skills

Education

Associates Degree

Tools

Claims tracking tools

PBM systems

Workflow tools

Job description

Judi Health, a health technology company, seeks a Pharmacy Pricing Appeals Analyst to manage end-to-end intake, review, investigation, documentation, and processing of pharmacy pricing appeals. You will validate requests, research PBM and pharmacy claims, review invoices, analyze outcomes, and maintain records with strong attention to detail.

You will work with the Manager, Pharmacy Pricing Appeals and partners in Analytics, Network Operations, Finance, and Compliance to ensure timely, accurate