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 Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single,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 (at least 3 days per week in our NYC, Denver, or Charlotte offices)
Position Summary
The Senior Lead Provider Network Onboarding and Integration will play a critical role in supporting the expansion of the TPA business by leading the onboarding, integration, and operational enablement of national, regional, direct contract provider networks and network aggregators. This role is responsible for establishing and maintaining network connectivity, ensuring seamless integration with internal claims platforms, and enabling TPA clients to leverage network services effectively.
The individual will serve as the bridge between network providers, technology teams, and operations (Claims Adjudications, Payments, and Customer Care), ensuring that all network capabilities are fully operational and aligned with client requirements.
Position Responsibilities:
- Lead onboarding of new national and regional healthcare networks as well as DPCs and COEs as part of TPA business growth strategy.
- Demonstrate strong ability to maintain a big-picture focus while balancing strategic and tactical priorities.
- Coordinate with both internal and external network stakeholders to establish contractual, operational, and technical readiness.
- Ensure network configurations align with business goals and client-specific requirements.
- Design and oversee integration of network services into TPA eco systems using API and file-based approaches.
- Enable core transactions between Judi Health and the network including, Claims, submission and adjudication workflows, Eligibility and benefits verification, Prior authorization processing, Provider data exchange and updates.
- Establish protocols for Member Identification cards and logos.
- Collaborate with Technology stakeholders to ensure secure, accurate, and scalable integrations in line with the industry as well as cybersecurity rigors.
- Troubleshoot and resolve integration issues, ensuring minimal disruption to operations.
- Ensure appropriate system configurations, access controls, and reporting capabilities are in place in terms of third-party systems use.
- Support go-live activities, including testing, validation, and transition to steady-state operations.
- Serve as a subject matter expert (SME) for network integration capabilities during client onboarding and implementations.
Required Qualifications:
- Bachelor’s degree in healthcare administration, Information Systems, Business, or a related field.
- Minimum of 5 years of experience in the healthcare network or managed care space, preferably within a TPA, payer, or network organization.
- Strong familiarity and hands-on experience with healthcare data exchange standards (EDI transactions such as 837, 835, 270/271, 278).
- Experience with API-based integrations and file-based data exchange mechanisms.
Preferred Qualifications
- Familiarity with claims platforms and provider focused healthcare technology ecosystems.
- Strong understanding of provider data management and network configuration.
- Experience working cross-functionally with operations, IT, and external vendors.
- Excellent problem-solving, communication, and stakeholder management skills.
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 in healthcare administration, Information Systems, Business, or a related field
- Minimum of 5 years of experience in healthcare networks or managed care, preferably within a TPA, payer, or network organization
- Hands-on experience with healthcare data exchange standards, including EDI transactions 837, 835, 270/271, and 278
- Experience with API-based integrations and file-based data exchange mechanisms
- Familiarity with claims platforms and provider-focused healthcare technology ecosystems
- Understanding of provider data management and network configuration
- Cross-functional experience with operations, IT, and external vendors
- Problem-solving, communication, and stakeholder management skills
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.
