Operations Analyst, Government Programs (EGWP)

Transformcap; United States; Hybrid; USD 66,000 - 99,000; Full time

Job summary

Judi Health in the United States is seeking a Government Programs Operations Analyst (EGWP) to provide operational and administrative support ensuring timely, compliant Health Plan activities. The role supports EGWP implementation and ongoing oversight of member touchpoints with the Medicare Part D PDP EGWP, aligning CMS guidance with employer and plan objectives.

Responsibilities include setup and go-live readiness, monitoring KPIs and CMS metrics, issue resolution with FDRs, overseeing

Qualifications

• Minimum of HS diploma/GED or equivalent experience.
• 3+ years of Medicare Part D and/or EGWP experience.
• Experience with Medicare Part D enrollment, call center and member communication requirements and reporting.
• Experience working in a delegated and highly matrixed organization.
• Strong operational acumen.
• Strong analytical acumen.

Responsibilities

• Support EGWP program setup, implementation and go-live readiness across assigned internal functions and delegate oversight, which includes enrollment, claims processing, member services, member communications, CAHPS activities and associated member service STARs activities.
• Monitor daily, weekly and monthly performance, operational KPIs and CMS compliance metrics for enrollment, member services, and member communications.
• Support with issue resolution and corrective action completion with related, first tier and downstream entities (FDRs).
• Perform oversight of monthly enrollment audits performed by CMS and semi-annual enrollment reporting.
• Perform oversight of member services and member communications through call evaluations and random sample review or materials and documentation.
• Ensure timely and accurate reporting information is received from both internal and external resources as required by the Health plan.
• Collaborate with account management and/or employer groups on enrollment issues to be resolved by Employer groups to ensure timeliness and compliance with CMS guidance
• Develop compliant documentation for operational areas to include policies, procedures, workflows and other work instructions.
• Support additional functions, as needed.

Skills

Medicare Part D experience

Enrollment and member communications

Analytical acumen

Operational acumen

Education

HS diploma/GED

Tools

HPMS

MARx

CMS systems

Job description

About Judi Health

Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels.
At Judi Health, we're deploying the infrastructure our country needs to deliver the healthcare we all deserve. We are the intelligence platform powering benefits plans for millions of Americans and proudly leading the next generation of care. To learn more, visit www.judi.health.

Location: Hybrid (Local to NYC, Denver, CO or Charlotte, NC)

Position Summary

The Government Programs Operations Analyst (EGWP) provides operational and administrative support to ensure day to day Health Plan activities are performed timely and compliantly. The role will be responsible for supporting EGWP implementation and the ongoing oversight of member touchpoint activities with the Medicare part D Prescription Drug Plan (PDP) Employer Group Waiver Plan (EGWP). This role will perform the day to day functional activities to ensure compliance with the Centers of Medicare and Medicaid (CMS) regulations while meeting employer, member and Health Plan financial objectives.

Position Responsibilities

• Support EGWP program setup, implementation and go-live readiness across assigned internal functions and delegate oversight, which includes enrollment, claims processing, member services, member communications, CAHPS activities and associated member service STARs activities.
• Monitor daily, weekly and monthly performance, operational KPIs and CMS compliance metrics for enrollment, member services, and member communications.
• Support with issue resolution and corrective action completion with related, first tier and downstream entities (FDRs).
• Perform oversight of monthly enrollment audits performed by CMS and semi-annual enrollment reporting.
• Perform oversight of member services and member communications through call evaluations and random sample review or materials and documentation.
• Ensure timely and accurate reporting information is received from both internal and external resources as required by the Health plan.
• Collaborate with account management and/or employer groups on enrollment issues to be resolved by Employer groups to ensure timeliness and compliance with CMS guidance
• Develop compliant documentation for operational areas to include policies, procedures, workflows and other work instructions.
• Support additional functions, as needed.

Required Qualifications

• Minimum of HS diploma/GED or equivalent experience
• 3+ years of Medicare Part D and/or EGWP experience
• Experience with Medicare Part D enrollment, call center and member communication requirements and reporting
• Experience working in a delegated and highly matrixed organization.
• Strong operational acumen
• Strong analytical acumen

Preferred Qualifications

• Health Plan Medicare Part D and/or EGWPs
• Experience working within CMS systems, including but not limited to HPMS and MARx.
• Experience with Federal and State Audits

• New York, NY: $78,800 — $98,500 USD
• Denver, CO: $72,000 — $90,000 USD
• Charlotte, NC: $65,600 — $82,000 USD

All employees are responsible for adherence to the Judi Health Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.

We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at https://www.judi.health/legal/privacy-policy.