Analyst, Data Exchange - Eligibility

About this role

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. To learn more, visit www.judi.health.


Location: Remote


About Capital Rx
Capital Rx is a next-generation pharmacy benefits manager, overseeing prescription benefit plans on behalf of employers, unions, and government entities. Determined to transform an outdated model, Capital Rx’s mission is to change how prescription benefits are priced and administered in the US, unlocking enduring social change. Through our platform approach, Capital Rx delivers data-driven insights and actionable strategies that reduce costs, while improving patient outcomes. Our commitment to innovation, technology, and service is why Capital Rx is among the fastest-growing PBMs in the country.


Position 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
• Acting as a healthcare data subject matter expert on Eligibility guidelines and Electronic Data Interchange (EDI) protocols
• Serving as a point of coordination for member eligibility issue identification and issue resolution with internal teams and external partners
• Identify and triage ...