Remote PBM Benefit Configuration & Validation Specialist

Judi Health; New York (NY); Híbrido; USD 62 400 - 98 500; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Medical insurance

Dental and vision

401(k) plan

Paid time off

Remote/hybrid work options

Resumo da oferta

Judi Health in the United States seeks a Benefit Configuration Specialist to support testing and validation of pharmacy benefit plan configurations across Commercial, Medicaid, Exchange, and Medicare lines.

You will translate plan design documents into executable test scenarios, audit configurations for regulatory compliance, analyze claim outputs, and collaborate with cross‑functional teams to ensure accurate benefit setups in a deadline‑driven environment.

Qualificações

• Bachelor’s degree or equivalent experience in a related field.
• 3–5 years of PBM or health plan operations experience.
• Experience testing pharmacy benefit configurations in multiple lines.

Responsabilidades

• Execute end-to-end testing and validation of benefit plan configurations.
• Review plan design documents and formulary specs to write test scenarios.
• Analyze claim outputs to confirm adjudication behavior and accumulators.
• Identify defects and coordinate with the configuration team for remediation.
• Ensure compliance with federal and state regulations including CMS guidance.

Conhecimentos

Analytical thinking

Attention to detail

Communication skills

Client-facing

Excel proficiency

Formação académica

Bachelor's degree in Healthcare Administration, Business, Information Systems, or related field

Ferramentas

Microsoft Excel

Descrição da oferta de emprego

Judi Health in the United States seeks a Benefit Configuration Specialist to support testing and validation of pharmacy benefit plan configurations across Commercial, Medicaid, Exchange, and Medicare lines.

You will translate plan design documents into executable test scenarios, audit configurations for regulatory compliance, analyze claim outputs, and collaborate with cross‑functional teams to ensure accurate benefit setups in a deadline‑driven environment.