Medicare EGWP Operations Analyst (Hybrid)

Capital Rx; Denver (CO); Hybrid; USD 72,000 - 99,000; Full time

Job summary

Judi Health, a health technology company, seeks a Government Programs Operations Analyst (EGWP) to support Medicare Part D implementation and ongoing compliance with CMS regulations. The role focuses on enrollment, claims processing, member services, and reporting.

The ideal candidate brings 3+ years of Medicare Part D and/or EGWP experience, strong operational and analytical skills, and experience in a delegated, matrixed organization. Hybrid work local to NYC, Denver, or Charlotte preferred.

Qualifications

• Requires 3+ years of Medicare Part D and/or EGWP experience.
• Experience with Medicare Part D enrollment, call center, and member communications reporting.
• Experience working in a delegated and highly matrixed organization.
• Strong operational and analytical skills.

Responsibilities

• Support EGWP program setup, implementation and go-live readiness across enrollment, claims processing, member services and related communications.
• Monitor daily/weekly/monthly performance, KPIs and CMS compliance metrics.
• Assist with issue resolution and corrective actions with related entities (FDRs).
• Oversee monthly CMS enrollment audits and semi-annual enrollment reporting.
• Supervise member services and communications via call evaluations and sample reviews.
• Ensure timely reporting information from internal and external resources per Health plan requirements.
• Collaborate with account management on enrollment issues to ensure CMS guidance compliance.
• Develop compliant documentation for policies, workflows and procedures.
• Support additional functions as needed.

Skills

Medicare Part D experience

EGWP experience

Operational acumen

Analytical acumen

Education

HS diploma/GED

Job description

Judi Health, a health technology company, seeks a Government Programs Operations Analyst (EGWP) to support Medicare Part D implementation and ongoing compliance with CMS regulations. The role focuses on enrollment, claims processing, member services, and reporting.

The ideal candidate brings 3+ years of Medicare Part D and/or EGWP experience, strong operational and analytical skills, and experience in a delegated, matrixed organization. Hybrid work local to NYC, Denver, or Charlotte preferred.