Lead Medical Claims Pricing Architect

Capital Rx Inc.; Charlotte (NC); Hybrid; USD 107,000 - 134,000; Full time

Job summary

Judi Health is seeking a Lead Medical Network Pricer to act as the pricing expert for medical claims in a technology-enabled environment. You will interpret contracts, apply Medicare-based pricing and RBP, and maintain reimbursement data sets.

You will work with Product and Engineering to automate pricing logic and ensure auditable results. The role requires deep knowledge of pricing methodologies, strong Excel/SQL skills, and the ability to lead pricing efforts for new client implementations

Qualifications

• Bachelor's degree in finance, economics, business, healthcare administration, health information management, data analytics, mathematics, information systems, or a related field.
• 7+ years of progressive experience in medical claim pricing, provider reimbursement, or related fields.
• Expertise in Medicare-based reimbursement, Reference-Based Pricing, and professional/institutional pricing.
• Strong Excel and data-analysis skills; knowledge of SQL and BI tools is preferred.

Responsibilities

• Interpret client reimbursement requirements and translate into pricing logic for the platform.
• Manually price a wide range of medical claims using approved methodologies.
• Define and document pricing rules, data dependencies, and decision criteria.
• Lead pricing support for client implementations, fee schedules, and platform updates.
• Develop controls, reviews, and dashboards to ensure accuracy and financial integrity.
• Collaborate with Product and Engineering to translate pricing workflows into automation.

Skills

Pricing strategy

Contract interpretation

Reimbursement policies

Manual pricing

Medicare pricing

Reference-Based Pricing

Data analysis

SQL

Excel

BI tools

Pricing automation

Regulatory/compliance

Communication

Education

Bachelor's degree in finance, economics, business, healthcare administration, health information management, data analytics, mathematics, information systems, or related field

Tools

Excel

SQL

BI tools

Pricing platforms

Job description

Judi Health is seeking a Lead Medical Network Pricer to act as the pricing expert for medical claims in a technology-enabled environment. You will interpret contracts, apply Medicare-based pricing and RBP, and maintain reimbursement data sets.

You will work with Product and Engineering to automate pricing logic and ensure auditable results. The role requires deep knowledge of pricing methodologies, strong Excel/SQL skills, and the ability to lead pricing efforts for new client implementations