Data Exchange Manager - Claims Operations

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.

About the role

The Data Exchange Manager leads day-to-day Data Exchange operations for both PBM and TPA (Medical, Dental, Vision) business lines. The role oversees analysts and specialists responsible for healthcare data integrations, client onboarding, EDI transactions, eligibility feeds, claims exchanges, configuration setup, data-quality monitoring, and operational-issue resolution. The manager partners with internal teams and external partners to design, maintain, and troubleshoot data-exchange processes that support claims, formulary, network, and eligibility operations.

Responsibilities

• Lead and develop Data Exchange staff across PBM and TPA operations.
• Oversee connectivity setup and configuration activities for all new and existing clients.
• Manage healthcare data-exchange operations, connectivity, onboarding, and production support.
• Direct PBM integrations including eligibility, claims, accumulator, formulary, and network data.
• Oversee TPA EDI transactions (834, 837, 835, 270/271, 276/277, 278).
• Ensure data quality, reconciliation, audits, and issue resolution.
• Partner with Implementations, Client Services, Product, Engineering, and external trading partners.
• Drive automation, process improvement, and operational excellence.
• Ensure HIPAA and regulatory compliance.
• Serve as a central coordination point for issue identification, triage, and resolution across internal teams and external integration partners.
• Monitor system status, data movement, and platform dashboards to proactively detect abnormalities.
• Remediate data-exchange issues according to established SLAs, operating standards, and audit controls.
• Perform and oversee audits and reconciliation processes to validate data integrity.
• Collaborate with Implementation, Operations, Client Success, Product, and Engineering to support client onboarding, migrations, vendor changes, and enhancement requests.
• Act as a liaison across business areas to ensure alignment, clear communication, and coordinated prioritization.
• Translate business requests into technical requirements, assess complexity, and support accurate effort estimation and SLA assignment.
• Identify opportunities to streamline workflows, enhance data quality, and reduce operational risk through automation and process refinements.
• Develop and maintain comprehensive documentation—including policies, procedures, and configuration standards for JUDI system operations.
• Stay current with Medicare, Medicaid, and state regulatory requirements to ensure compliance.
• Follow and reinforce the JUDI Health Code of Conduct, including escalation and reporting of noncompliance.

Requirements

• Bachelor’s degree or equivalent experience.
• 5+ years in healthcare data exchange, EDI, PBM, or claims administration.
• Leadership experience within a PBM or healthcare setting, preferably managing high-volume data exchange or interoperability functions.
• Knowledge of PBM and TPA data structures and healthcare EDI standards.
• Proficiency in SQL, Excel, and other analytical tools preferred.
• Exceptional analytical skills with the ability to diagnose root causes and propose effective solutions.
• Strong communication skills with the ability to build and maintain relationships across technical and non-technical stakeholders.
• Highly organized, self-motivated, and able to manage multiple priorities in a fast-paced environment.

Pay

• New York, NY: $150,800 – $188,500 USD
• Denver, CO: $138,000 – $172,500 USD
• Charlotte, NC: $125,600 – $157,000 USD

Schedule

Hybrid – 3 days in-office (locations in NYC, Denver, CO, and Charlotte, NC area).