Candidates with PBM and premium billing experience with technical skills in Excel and SQL will find this process-driven role in healthcare finance. The hybrid work arrangement and focus on non-core program invoicing suggest a need for adaptability and cross-functional collaboration.
Derived from job-description analysis by Serendipath's career intelligence engine.
Original posting from Judi Health via Greenhouse
About Judi Health
Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels.
At Judi Health, we're deploying the infrastructure our country needs to deliver the healthcare we all deserve. We are the intelligence platform powering benefits plans for millions of Americans and proudly leading the next generation of care. To learn more, visit www.judi.health.
Location: Hybrid - 3 days in office (NYC, Denver or Charlotte)
Position Summary:
This Senior Analyst role is a critical position for Client Financial Operations focusing on the support and administration of invoicing related to areas of business outside of core PBM and PBA services, in particular EGWP. This role will be an instrumental player in developing invoicing processes for other new programs and also drive process improvement within existing non-core services. The individual must have a strong financial background in PBM and premium billing and be comfortable working with Excel and SQL formulas to efficiently run processes.
Position Responsibilities:
- Own and oversee billing operations for non-core programs, including EGWP, by interpreting complex, multi-year contracts, client program requirements, service volumes, fee structures, and financial data to determine appropriate billing approaches.
- Independently evaluate incomplete, conflicting, or unusual billing information; compare alternative courses of action; resolve material issues within established authority; and escalate matters requiring broader approval with a recommended solution.
- Interpret contract terms, and client-specific arrangements to identify billable items, establish appropriate billing mechanisms, and advise internal partners on financial and operational implications.
- Design, implement, and refine invoicing processes, controls, schedules, and operating practices for new and existing programs, coordinate with technology teams when standard procedures do not cover contractual requirements.
- Analyze data from financial, adjudication, membership, and other operational systems to assess billing accuracy, identify trends and financial exposure, determine root causes, and recommend corrective or preventive action.
- Direct invoice preparation, reconciliation, and issuance in accordance with contractual requirements.
- Lead reconciliations across ERP, adjudication, and related platforms; assess the significance of variances; determine appropriate resolution; and coordinate implementation with Finance, Client Services, Operations, and other stakeholders.
- Evaluate existing processes and controls, prioritize improvement opportunities, and use Excel, SQL, or other analytical tools to develop automation and redesign solutions that improve accuracy, scalability, and financial governance.
- Develop and maintain billing policies, procedures, decision criteria, and supporting documentation; recommend changes to operating practices and help implement approved improvements across affected business areas.
- Lead audit and compliance support for assigned programs.
Required Qualifications:
- Undergraduate bachelor’s degree in Business, Finance, or quantitative field
- 5+ years of related experience in finance, data analysis, or accounting
- Experience specific to EGWP Premium invoicing
- Strong Excel and SQL Skills
- Ability to challenge and improve existing processes through automation and redesign
- Motivated team player with the ability to work in a fast-paced, forward-moving environment
- Attention to detail & commitment to delivering high quality work
- Passion for healthcare and for driving lasting change in pharmacy benefits
- Ability to define problems, collect data, establish facts, solve problems, make recommendations, anddraw valid conclusions in a timely and accurate manner
- PBM experience preferred
New York, NY Salary Range$92,100—$115,000 USDDenver, CO Salary Range$84,400—$105,500 USDCharlotte, NC Salary Range$76,800—$96,000 USDAll employees are responsible for adherence to the Judi Health Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.
We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at https://www.judi.health/legal/privacy-policy.
Source: Judi Health careers (Greenhouse)