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 Manager, SIU - Pharmacy Investigations is a strategic and hands-on leader with required prior pharmacy investigation experience who is responsible for the effective operation, oversight, and continuous improvement of the pharmacy Fraud, Waste, and Abuse (FWA) investigations program. This role leads complex pharmacy investigations, develops a high-performing team, strengthens investigative standards, and ensures matters are handled consistently, objectively, and in accordance with applicable requirements. Found on 1752vc Careers, the job board for startup and VC roles.
What they're looking for
- Leadership: Proven experience leading investigators, managing competing priorities, strengthening team performance, and driving complex matters to clear and defensible outcomes
- Analytical Capability: Demonstrated ability to interpret claims data, identify anomalous patterns, assess risk, connect information across sources, and convert findings into actionable recommendations
- Communication: Exceptional written, verbal, and presentation skills, including the ability to explain complex investigative matters to executives, clients, regulators, attorneys, and operational partners
- Judgment: Sound decision-making, objectivity, attention to detail, and the ability to handle confidential, high-risk, and time-sensitive matters with discretion
- Education: Bachelor's degree in healthcare, criminal justice, compliance, business, data analytics, or a related field, or equivalent relevant experience
- Certification: AHFI, CFE, pharmacy technician certification, HCAFA, or another relevant investigation, compliance, or pharmacy credential required, multiple relevant credentials preferred
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 Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single,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 .
Join Judi Rx in advancing pharmacy benefit integrity through disciplined investigations, regulatory expertise, and data-driven action.
The Manager, SIU - Pharmacy Investigations is a strategic and hands-on leader with required prior pharmacy investigation experience who is responsible for the effective operation, oversight, and...
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