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 Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single,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.
Location: Hybrid 3 days (offices in NYC, Denver, CO and Charlotte, NC area)
As an Account Manager focused on PBA and Medicare, you'll be at the forefront of delivering seamless client experiences by managing benefit changes, implementing new plans, and ensuring pricing accuracy—all while driving impactful solutions that directly shape business success. You’ll lead key quality assurance initiatives, proactively identify claim discrepancies, and collaborate across teams to streamline processes, making a tangible impact on client satisfaction and operational efficiency. Your expertise will be essential in shaping client strategies, resolving complex issues, and upholding the values that keep Capital Rx ahead of the competition.
Position Responsibilities:
- Partner with clinical account manager (CAM) and account executive (AE) to manage clients through the entire lifecycle from implementation through go-live and renewal on a designated book of business
- Support implementation as a critical member of the client management teams with all day-to-day client requirements
- Responsible for timely and accurate management and execution of all client benefit requests, including benefit changes, eligibility changes, override requests, demos and new implementations
- Analyze incoming client requests and work with internal and external teams to complete required plan documentation
- Support implementation of new plans, pricing, and networks, consistent with strategic or administrative intent
- Lead pre- and post-implementation quality assurance and testing to validate coding accuracy
- Lead claim reviews to proactively identify discrepancies or inaccuracies and develop solutions to address
- Travel requirements not to exceed 25%
- Handle and resolve sponsor and member issues, escalating as needed
- Research and respond to claims processing and system configuration inquiries
- Coordinate integration of other data inputs into client management processes
- Collaborate cross functionally to support general client operations, as required
- Responsible for relationship management and contribution to successful NPS and Account Management Survey results, along with retention support
Qualifications:
- Undergraduate bachelor’s degree, with record of strong academic performance
- 5+ years of proven experience in PBM / health plan, benefits consulting, healthcare
- Track record of building trusting internal and external relationships
- Track record of leading cross-functional initiatives, driving high performance, meeting deadlines, and executing on deliverables
- Experience working with structured and unstructured data
- Proficient in Microsoft Office, SQL a bonus
- Ability to balance multiple complex projects simultaneously
- Exceptional written and verbal communication skills
- Extremely flexible, highly organized, and able to shift priorities easily
- Attention to detail & commitment to delivering high quality work product
All employees are responsible for adherence to the Judi Health 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.
We 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.
Skills Required
- Bachelor's degree with a record of strong academic performance
- 5+ years of experience in PBM, health plans, benefits consulting, or healthcare
- Experience building trusting internal and external relationships
- Experience leading cross-functional initiatives, driving performance, meeting deadlines, and executing deliverables
- Experience working with structured and unstructured data
- Proficiency in Microsoft Office
- SQL experience
- Ability to balance multiple complex projects simultaneously
- Exceptional written and verbal communication skills
- Flexibility, strong organization, and ability to shift priorities
- Strong attention to detail and commitment to high-quality work
What We Do
Judi Health is a 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™: full-service health benefit management for employers, TPAs, and health plans - Judi®: a single, scalable SaaS solution that health plans can utilize to manage all their claim workflows Through these solutions, Judi Health is executing on its mission to give our country the infrastructure it needs for the healthcare we deserve. To learn more, visit www.judi.health.
