Pharmacy Pricing Appeals Analyst

Capital Rx; New York (NY); Hybrid; USD 56,000 - 72,000; Full time

Job summary

Judi Health seeks a Pharmacy Pricing Appeals Analyst to manage end-to-end intake, review, and processing of pharmacy pricing appeals. You will validate requests, research PBM and claims, review invoices, and document decisions in our tracking systems.

Collaborate with the Manager of Pharmacy Pricing Appeals and cross-functional teams in Analytics, Finance, Compliance, and Network Operations. The role requires attention to detail, claims knowledge, and the ability to handle multiple appeals

Qualifications

• 2–4 years of PBM/pharmacy claims experience
• Associates degree preferred or equivalent experience
• Experience researching and resolving pharmacy claims
• Experience with claims data and invoicing records
• Working knowledge of PBM claims processes
• Advanced Excel skills (filters, sorts, templates)

Responsibilities

• Research pharmacy claim details and document findings
• Compare payment data against invoices and costs
• Understand PBM and pharmacy claims terminology and adjudication
• Communicate clearly with stakeholders and pharmacy contacts
• Maintain audit-ready records

Skills

PBM experience

Pharmacy operations

Pharmacy claims

Data analysis

Excel skills

Education

Associates Degree preferred

Tools

Claims tracking tools

Spreadsheets

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 Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing architecture, seamlessly consolidating pharmacy and medical benefit administration on a single,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 3 days in Charlotte, NYC or Denver office

Position Summary:

The Pharmacy Pricing Appeals Analyst is responsible for the end-to-end intake, review, investigation, documentation, and processing of pharmacy pricing appeals. This role supports timely and accurate appeal resolution by validating pharmacy appeal requests, researching PBM and pharmacy claims, reviewing invoices and acquisition cost documentation, analyzing reimbursement outcomes, documenting appeal decisions, and maintaining appeal records in tracking systems and workflow tools.

The analyst will work closely with the Manager, Pharmacy Pricing Appeals, as well as cross-functional partners in Analytics, Network Operations, Finance, Compliance, and related operational teams. The role requires strong attention to detail, pharmacy claims knowledge, analytical judgment, and the ability to manage multiple appeal requests through established deadlines and documentation standards.

Position Responsibilities:

• Claims Investigation - Ability to research pharmacy claim details, validate identifiers and document findings
• Analytical Thinking - Ability to compare pharmacy claim payment data against invoice and acquisition cost
• Pharmacy Claims Knowledge - Understanding of PBM and pharmacy claims terminology, adjudication, and reimbursement concepts
• Communication - Clear written and verbal communication with internal stakeholders and pharmacy contacts
• Data Integrity - Commitment to accurate, complete and audit ready records

Required 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 in reviewing pharmacy claim data, adjudication results, Rx numbers, NDC's and pharmacy identifiers, invoice documentation, and operational records with strong accuracy
• Experience working with claims tracking tools, workflow tickets, spreadsheets, and operational documentation
• Working knowledge of pharmacy reimbursement concepts and PBM claims processes
• Intermediate to advanced Microsoft excel skills, including accurate data entry, filtering, sorting and working with templates

Preferred Qualifications:

• Certified Pharmacy Technician [CPhT] preferred, but not required
• Intermediate coding experience preferred, but not required
• Retail, specialty, mail-order, managed care or PBM pharmacy experience
• Experience with pharmacy pricing, network reimbursement, MAC appeals, acquisition cost review, or related pharmacy reimbursement processes
• Experience using internal pharmacy adjudication systems, reporting, or data output tools to support claims research
• Experience with compliance-driven operational processing and documentation standards

Salary Range

New York, NY Salary Range: $27.31—$34.13 USD

Denver, CO Salary Range: $25—$31.25 USD

Charlotte, NC Salary Range: $22.69—$28.37 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 athttps://www.judi.health/legal/privacy-policy.