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 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.
What they're looking for
- 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
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 Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single,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 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...
Browse similar: Startup jobs