Benefit Operations Specialist

📋 Description

• • Join our first-of-its-kind Integrated Benefits team as a Benefit Operations Specialist, where you will play a pivotal role in delivering comprehensive medical and pharmacy benefit programs for Judi Health clients. You will lead benefit configuration, claims testing, and quality assurance processes, ensuring accuracy and efficiency across all implementations. This position offers the opportunity to influence operational best practices and contribute to a team that is redefining how integrated benefits are delivered in the healthcare space.
• • Responsible for all aspects of benefit configuration, including new plan setup, plan change setup, claims testing, and regular audits; drives cross-functional collaboration with product/dev teams and stakeholders to ensure client requests are configurable; communicates benefit setup and testing processes clearly to non-expert users; makes recommendations to streamline work processes and systems impacting plan/benefit design for efficiency and quality outcomes.
• • Works cross-functionally to create new benefit options aligned with market needs, including government program expansions; develops standards and custom batch testing scenarios, reviews test claims output to validate accuracy against client benefit design; develops standard policies, procedures, and training materials for cross-functional teams; maintains quality levels and production SLA response times.
• • Participates in client meetings to assess new benefit information or change requests, ensuring Judi logic aligns with intended benefit configuration; partners with leadership to develop benefit plan designs meeting client requests, Health Plan strategic parameters, and regulatory requirements; partners with Client Services during go-live to troubleshoot benefit-related discrepancies; supports general business or team needs as assigned; adheres to Capital Rx Code of Conduct including reporting noncompliance.
• • About the team or company: 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 PBM solutions), Judi Health™ (full-service health benefit management), and Judi® (the industry’s leading proprietary Enterprise Health Platform consolidating claim administration workflows). Together with clients, we’re rebuilding trust in U.S. healthcare and deploying infrastructure for the care we deserve.
• • What the person can learn or achieve in this role: Gain deep expertise in integrated medical and pharmacy benefit configuration, claims testing, and quality assurance within a fast-paced, innovative healthcare technology environment; develop skills in cross-functional collaboration, process optimization, regulatory compliance (including ERISA, Medicare/Government programs), and client-facing communication; contribute to shaping operational best practices in a mission-driven organization redefining healthcare delivery.