Benefit Configuration Specialist

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.

Position Summary

The Benefit Configuration Specialist is responsible for supporting the testing and validation of pharmacy benefit plan configurations across multiple lines of business, including Commercial, Medicaid, Exchange, and Medicare.

Responsibilities

• Execute end-to-end testing and validation of pharmacy benefit plan configurations across Commercial, Medicaid, Exchange, and Medicare lines of business.
• Perform detailed implementation audits to ensure benefit setup aligns with client intent, regulatory requirements, and internal configuration standards.
• Review and interpret plan design documents, benefit change forms, and formulary specifications to translate requirements into executable test scenarios.
• Analyze claim outputs to confirm expected adjudication behavior and accumulator movement.
• Identify, document, and communicate configuration discrepancies or defects; collaborate with configuration team to ensure timely resolution.
• Ensure compliance with applicable federal and state regulations, including guidance from the Centers for Medicare & Medicaid Services (CMS) where applicable.
• Maintain clear documentation of testing results, audit findings, and approval signoffs.
• Participate in client-facing meetings to review testing scope, discuss audit findings, clarify benefit intent, and provide detailed explanations of testing results and configuration outcomes.
• Partner with cross-functional teams to ensure benefit accuracy and successful implementation.
• Contribute to process improvements that enhance testing efficiency, audit quality, and overall benefit validation standards.
• Manage multiple audits and testing initiatives simultaneously in a deadline-driven environment.
• Responsible for adherence to the Capital Rx Code of Conduct.

Required Qualifications

• Bachelor’s degree in Healthcare Administration, Business, Information Systems, or related field (or equivalent work experience).
• Minimum 3–5 years of experience in pharmacy benefit management (PBM), health plan operations, or benefit configuration.
• Demonstrated understanding of Medicare benefit structures.
• Experience testing and validating pharmacy benefit configurations in Commercial, Medicaid, Exchange, and/or Medicare lines of business.
• Strong knowledge of formulary design, tier structures, utilization management (PA, ST, QL), and accumulator logic.
• Ability to analyze benefit design documents and translate requirements into executable test scenarios.
• Strong analytical skills with high attention to detail and accuracy.
• Proficiency in Microsoft Excel for data review, validation, and reporting.
• Strong written and verbal communication skills with ability to clearly document findings and discrepancies.
• Participate in client-facing discussions to review benefit testing outcomes and implementation readiness while providing clear guidance on complex benefit designs.

Benefits

• Medical and pharmacy coverage
• Dental insurance
• Vision insurance
• Accidental injury insurance
• Critical illness insurance
• Hospital indemnity insurance
• Flexible spending accounts
• Health savings account
• Voluntary life insurance
• Voluntary accidental death and dismemberment insurance
• Paid time off
• Sick time
• Holidays
• Short-term disability
• Long-term disability
• Employee assistance program
• Wellness program
• 401(k) plan with company match

Pay

• New York, NY (hybrid): $78,800 - $98,500
• Denver, CO (hybrid): $72,000 - $90,000
• Remote: $62,400.00 - $90,000.00

Schedule

Location: Remote (For Non-Local) or Hybrid (Local to New York, NY or Denver, CO area)

Qualifications

Nothing in this position description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

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.

Capital Rx

Capital Rx 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.

Equal Opportunity Employer

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. Remote, US Salary Range: $75,000 USD - $90,000 USD All employees are responsible for adherence to the Capital Rx Code of Conduct including the reporting of non-compliance.

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