Hybrid Pharmacy Pricing Appeals Specialist

Capital Rx; Denver (CO); Hybrid; USD 3,444,000 - 4,312,000; Full time

Job summary

Judi Health is a health technology company delivering Unified Claims Processing for pharmacy and medical benefit administration. The Pharmacy Pricing Appeals Analyst will review and resolve pricing appeals, validate PBM data, and document outcomes while coordinating with Analytics, Network Operations, Finance, and Compliance.

The role emphasizes attention to detail, claims knowledge, and timely processing within established deadlines.

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.

Responsibilities

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

Skills

PBM experience

Pharmacy claims

Analytical thinking

Communication

Data integrity

Education

Associate's Degree preferred

Tools

Claims tracking tools

Spreadsheets

Workflow tickets

Job description

Judi Health is a health technology company delivering Unified Claims Processing for pharmacy and medical benefit administration. The Pharmacy Pricing Appeals Analyst will review and resolve pricing appeals, validate PBM data, and document outcomes while coordinating with Analytics, Network Operations, Finance, and Compliance.

The role emphasizes attention to detail, claims knowledge, and timely processing within established deadlines.