Analyst, Data Exchange - Eligibility
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AI Summary
About Judi Health
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including:
- Capital Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers,
- Judi Health™, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and
- Judi®, the industry’s leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform.
Together with our clients, we’re rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit www.judi.health.
Location: Remote (For Non-Local) or Hybrid (Local to Denver, CO or NYC area)
Position Responsibilities:
- Attend new client implementation meetings with external partners to discuss eligibility requirements and protocols
- Recommend eligibility file formats to external partners and coordinate receipt and processing of eligibility data
- Acting as a healthcare data subject matter expert on Eligibility guidelines and Electronic Data Interchange (EDI) protocols
- Serving as a point of coordination for member eligibility issue identification and issue resolution with internal teams and external partners
- Identify and triage eligibility issues and support the resolution of all errors related to transferring, loading, and management of eligibility data
- Proactively monitoring system status and eligibility data to quickly identify potential abnormalities that might impact quality and accuracy
- Ensuring that all issues and errors are resolved using designated operating standards and within defined service levels
- Assist with the validation of eligibility data integrity through regular audits and reconciliation processes
- Ensure accurate and timely entry of group/plan structure determinations for benefits and enrollment
- All employees are responsible for adherence to the Judi Health Code of Conduct including reporting of noncompliance.
Required Qualifications:
- Bachelor’s degree
- 1+ years of previous work experience, preferably in PBM, Healthcare, Data Exchange, and Eligibility
- Ability to match key PBM concepts and data fields across various systems and file layouts to ensure consistency and accuracy of data transfers
- Ability to analyze complex business problems to discover and resolve root causes
- Proficiency in SQL, Excel, JSON and other technical data skills preferred
- Strong communication skills with the ability to develop effective work relationships with internal and external stakeholders
- Self-motivated and detail-oriented problem solver
- Ability to handle multiple competing priorities in a dynamic environment and collaborate in a team
This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.
This range represents the low and high end of the anticipated base salary range. The actual base salary will depend on several factors such as: experience, knowledge, skills, and location of the job.
All employees are responsible for adherence to the Capital Rx Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.
Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
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.
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