other
Posted May 4Benefit Configuration Specialist
at Judi Health
Denver, United StatesHybrid
Responsibilities
- Execute end-to-end testing and validation of pharmacy benefit plan configurations across Commercial, Medicaid, Exchange, and Medicare lines of business.
- Perform detailed implementation audits to ensure benefit setup aligns with client intent, regulatory requirements, and internal configuration standards.
- Review and interpret plan design documents, benefit change forms, and formulary specifications to translate
- Analyze claim outputs to confirm expected adjudication behavior and accumulator movement.
- Identify, document, and communicate configuration discrepancies or defects; collaborate with configuration team to ensure timely resolution.
- Ensure compliance with applicable federal and state regulations, including guidance from the Centers for Medicare & Medicaid Services (CMS) where applicable.
- Maintain clear documentation of testing results, audit findings, and approval signoffs.
- Manage multiple audits and testing initiatives simultaneously in a deadline-driven environment.
Requirements
- Judi® , the industry’s leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform.
- This position requires strong attention to detail, analytical thinking, and the ability to interpret complex pharmacy benefit structures.
- Bachelor’s degree in Healthcare Administration, Business, Information Systems, or related field (or equivalent work experience).
- 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).
- Demonstrated understanding of Medicare benefit structures. •
- Strong knowledge of formulary design, tier structures, utilization management (PA, ST, QL), and accumulator logic.
- Ability to analyze benefit design documents and translate
- Proficiency in Microsoft Excel for data review, validation, and reporting.
- Strong written and verbal communication skills with ability to clearly document findings and discrepancies.
- Judi®, the industry’s leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform.