Job Overview
Location
Denver, Colorado, United States; New York, New York, United States; Remote
Job Type
Full-time
Category
HR & Recruiting
Date Posted
April 21, 2026
Full Job Description
đź“‹ Description
- • The Benefit Configuration Specialist supports the testing and validation of pharmacy benefit plan configurations across Commercial, Medicaid, Exchange, and Medicare lines of business, ensuring configurations align with client intent, regulatory requirements, and internal standards.
- • Day-to-day responsibilities include executing end-to-end testing, performing implementation audits, reviewing plan design documents, analyzing claim outputs, identifying and documenting configuration discrepancies, collaborating with cross-functional teams to resolve issues, maintaining documentation, participating in client-facing meetings, managing multiple audits simultaneously, and contributing to process improvements.
- • Capital Rx, part of Judi Health, is a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers, operating within an enterprise health technology company focused on rebuilding trust in healthcare through scalable, secure platforms like the Enterprise Health Platform (EHP).
- • In this role, the individual will deepen expertise in pharmacy benefit structures, regulatory compliance (including CMS guidance), benefit configuration testing, and cross-functional collaboration, while developing skills in audit leadership, process improvement, and client communication in a fast-paced, mission-driven environment.
🎯 Requirements
- • Bachelor’s degree in Healthcare Administration, Business, Information Systems, or related field (or equivalent work experience)
- • Minimum 3–5 years of experience in pharmacy benefit management (PBM), health plan operations, or benefit configuration
- • Direct experience supporting Medicare lines of business (Medicare Part D and/or MAPD) with demonstrated understanding of Medicare benefit structures
- • Experience testing and validating pharmacy benefit configurations in Commercial, Medicaid, Exchange, and/or Medicare lines of business
- • Strong knowledge of formulary design, tier structures, utilization management (PA, ST, QL), and accumulator logic
- • Proficiency in Microsoft Excel for data review, validation, and reporting
- • Strong analytical skills with high attention to detail and accuracy
- • Strong written and verbal communication skills with ability to clearly document findings and discrepancies
🏖️ Benefits
- • Medical, pharmacy, dental, vision, accidental injury, critical illness, and hospital indemnity insurance available for election
- • Health savings account (HSA), voluntary life insurance, and voluntary accidental death and dismemberment (AD&D) insurance for full-time employees
- • Basic life insurance, basic AD&D, paid time off, sick time, holidays, short-term and long-term disability, employee assistance program, and wellness program provided at no cost to full-time employees
- • 401(k) plan with company match after one year of full-time employment
- • Salary range: $75,000 – $90,000 USD, determined by geographic location and market tier
Skills & Technologies
About Capital Rx, Inc.
Capital Rx is a full-service pharmacy benefit manager and healthcare technology company that modernizes drug pricing and claims processing. Its cloud-based platform, JUDI, connects every aspect of the pharmacy ecosystem, enabling transparent, pass-through pricing and real-time analytics. The company administers formularies, rebates, and networks for employers, health plans, and government entities, aiming to lower prescription costs and improve patient outcomes.
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