Operations Analyst, Government Programs (EGWP)

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), 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

The Government Programs Operations Analyst (EGWP) provides operational and administrative support to ensure day-to-day Health Plan activities are performed timely and compliantly. The role supports EGWP implementation and ongoing oversight of member touchpoints with the Medicare Part D Prescription Drug Plan (PDP) Employer Group Waiver Plan (EGWP).

Responsibilities

• Support EGWP program setup, implementation, and go-live readiness across assigned internal functions—enrollment, claims processing, member services, member communications, CAHPS activities, and associated member-service STARs activities.
• Monitor daily, weekly, and monthly performance, operational KPIs, and CMS compliance metrics for enrollment, member services, and member communications.
• Support issue resolution and corrective-action completion with related first-tier and downstream entities (FDRs).
• Perform oversight of monthly enrollment audits conducted by CMS and semi-annual enrollment reporting.
• Perform oversight of member services and member communications through call evaluations and random-sample review of materials and documentation.
• Ensure timely and accurate reporting information is received from both internal and external resources as required by the Health Plan.
• Collaborate with account management and/or employer groups on enrollment issues to ensure timeliness and compliance with CMS guidance.
• Develop compliant documentation for operational areas, including policies, procedures, workflows, and other work instructions.
• Support additional functions as needed.

Requirements

• Minimum of HS diploma/GED or equivalent experience.
• 3+ years of Medicare Part D and/or EGWP experience.
• Experience with Medicare Part D enrollment, call-center operations, member-communication requirements, and reporting.
• Experience working in a delegated and highly matrixed organization.
• Strong operational and analytical acumen.

Preferred Qualifications

• Health Plan Medicare Part D and/or EGWP experience.
• Experience with CMS systems, including HPMS and MARx.
• Experience with Federal and State audits.

Pay

• New York, NY: $78,800 – $98,500 USD
• Denver, CO: $72,000 – $90,000 USD
• Charlotte, NC: $65,600 – $82,000 USD

Location: Hybrid (local to NYC, Denver, CO, or Charlotte, NC).