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 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. Learn more.

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 will be responsible for supporting EGWP implementation and the ongoing oversight of member touchpoint activities with the Medicare Part D Prescription Drug Plan (PDP) Employer Group Waiver Plan (EGWP). This role will perform the day-to-day functional activities to ensure compliance with the Centers of Medicare and Medicaid (CMS) regulations while meeting employer, member, and Health Plan financial objectives.

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

Responsibilities

• Support EGWP program setup, implementation, and go-live readiness across assigned internal functions and delegate oversight, which includes 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 performed 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 to include 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, and member communication requirements and reporting
• Experience working in a delegated and highly matrixed organization
• Strong operational acumen
• Strong analytical acumen

Qualifications

• Health Plan Medicare Part D and/or EGWPs experience
• Experience working within CMS systems, including but not limited to HPMS and MARx
• Experience with Federal and State Audits

Pay

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