Data Exchange Analyst - Eligibility

Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including Judi Rx (a public-benefit PBM for self-insured employers), Judi Health™ (full-service health benefit management for employers, TPAs, and health plans), and Judi®, the industry’s leading Enterprise Health Platform that consolidates all claim administration workflows in one scalable, secure platform. Together with our clients, we’re rebuilding trust in U.S. healthcare.

About the role

Hybrid schedule: 3 days in-office (locations in NYC, Denver, CO, or Charlotte, NC area).

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.
• Act as a healthcare data subject-matter expert on Eligibility guidelines and Electronic Data Interchange (EDI) protocols.
• Serve as the point of coordination for member eligibility issue identification and resolution with internal teams and external partners.
• Identify and triage eligibility issues and support resolution of errors related to transferring, loading, and management of eligibility data.
• Proactively monitor system status and eligibility data to quickly identify potential abnormalities that might impact quality and accuracy.
• Ensure all issues and errors are resolved using designated operating standards and within defined service levels.
• Assist with 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.
• Adhere to the Judi Health Code of Conduct, including reporting noncompliance.

Requirements

• 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.

Pay

• New York, NY: $96,800 – $121,000 USD
• Denver, CO: $88,000 – $111,000 USD
• Charlotte, NC: $80,800 – $101,000 USD