Judi Rx delivers transparent, member-focused PBM solutions, while Judi Care provides medical, vision, and dental benefits through Judi®, supporting millions of plan members across employers, unions, health systems, and government programs. Backed by General Catalyst.
About the role
The Government Programs Operations Analyst supports operational functions across Medicare, Medicaid, Exchange, and Commercial lines of business, with the primary responsibility of serving as the Reprocessing & Reversals (R&R) subject matter expert. The Analyst executes and validates R&R activities, provides operational and regulatory guidance, and works closely with Product and Development teams to design, test, and implement system and process enhancements.
What they're looking for
- 3+ years of experience in PBM or health plan operations, with experience supporting Medicare Part D, Medicaid, Exchange, and/or Commercial
- Proven subject matter expertise in pharmacy claim reprocessing and reversals, including complex claim corrections, operational controls, issue resolution, and downstream regulatory reporting impacts
- Advanced MS Excel skills (pivot tables, complex formulas, data modeling), familiarity with SQL or other data tools is a plus
- Demonstrated experience partnering with cross-functional teams to define business requirements, support solution design, perform user acceptance testing, manage defects, and implement operational enhancements
- Strong analytical and problem-solving skills, with a track record of driving operational improvements
- Strong written and verbal communication skills, with the ability to collaborate effectively with operational and technical stakeholders
More about this role
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 Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single,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 .
The Government Programs Operations Analyst supports operational functions across Medicare, Medicaid, Exchange, and Commercial lines of business, with the primary responsibility of serving as the Reprocessing & Reversals (R&R) subject matter expert. The Analyst executes and validates R&R activities, provides operational and...
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