Senior Business Analyst, Government Programs Operations Claims & Encounters

📋 Description

• • The Senior Business Analyst for Government Programs Operations Claims & Encounters at Capital Rx, Inc. plays a critical role in ensuring accurate and compliant government data submissions by analyzing complex healthcare data, documenting business requirements, and driving process improvements aligned with state and federal regulations.
• • Day to day, the role involves monitoring business process changes, gathering and analyzing stakeholder requests, conducting root-cause analysis of data and process issues, creating specifications for reports and data extracts, developing performance metrics, preparing training materials, and collaborating with cross-functional teams including compliance, product, clinical operations, and implementation to enhance government submission workflows.
• • Capital Rx, Inc. is a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions, operating under Judi Health, an enterprise health technology company that provides integrated health benefit management solutions and the proprietary Enterprise Health Platform (EHP) to employers, TPAs, and health plans, with a mission to rebuild trust in U.S. healthcare through scalable, secure technology.
• • In this role, the individual will deepen expertise in government healthcare programs, strengthen analytical and documentation skills, gain experience in process automation and optimization, and contribute directly to cost savings, regulatory compliance, and operational efficiency while working in a fast-paced, mission-driven environment.