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
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 at https://www.judi.health/legal/privacy-policy .
What they're looking for
- Bachelor’s degree preferred
- 3+ years of TPA / health plan experience in Claims Adjudication, Appeals, or other applicable department needs
- Advanced knowledge of appeals workflows, including documentation requirements for Providers and Administrators
- Ability to interpret multiple client plan designs and SPDs
- Familiarity with NSA regulations and the IDR Process
- Advanced knowledge of CPT, HCPCs, ICD-10, CDT coding a plus
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 Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single,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 .
Position Summary
Join our Judi Health TPA team as a Senior Coordinator, Appeals, where you will play a pivotal role in monitoring, handling and escalating appeals and provide support to multiple parties of our TPA team. You will help with daily operations of our TPA, including areas such as appeals, root cause analysis, IDR, and...
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