Benefit Configuration Specialist

About Judi Health Capital Rx, a public benefit corporation delivering full‑service pharmacy benefit management (PBM) solutions to self‑insured employers, Judi Health™, which offers full‑service health benefit management solutions to employers, TPAs, and health plans, and Judi®, the industry’s leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration‑related workflows in one scalable, secure platform. Location: Remote (for non‑local) or Hybrid (Local to New York, NY or Denver, CO area) Position Summary The Benefit Configuration Specialist supports testing and validation of pharmacy benefit plan configurations across Commercial, Medicaid, Exchange, and Medicare lines of business, ensuring benefit plan setups align with client intent, regulatory requirements, and internal standards. Responsibilities Execute end‑to‑end testing and validation of pharmacy benefit plan configurations across multiple lines of business. Perform detailed implementation audits to ensure benefit setups align with client intent, regulatory requirements, and internal configuration standards. Review and interpret plan design documents, benefit change forms, and formulary specifications to translate requirements into executable test scenarios. Analyze claim outputs to confirm expected adjudication behavior and accumulator movement. Identify, document, and communicate configuration discrepancies or defects; collaborate with the configuration team to ensure timely resolution. Ensure compliance with applicable federal and state regulations, including CMS guidance where applicable. Maintain clear documentation of testing results, audit findings, and approval signoffs. Participate in client‑facing meetings to review testing scope, discuss audit findings, clarify benefit intent, and provide detailed explanations of testing results. Partner with cross‑functional teams to ensure benefit accuracy and successful implementation. Contribute to process improvements that enhance testing efficiency, audit quality, and overall benefit validation standards. Manage multiple audits and testing initiatives simultaneously in a deadline‑driven environment. Adhere to the Capital Rx Code of Conduct. Required Qualifications Bachelor’s degree in Healthcare Administration, Business, Information Systems, or related field (or equivalent experience). Minimum 3–5 years of experience in pharmacy benefit management (PBM), health plan operations, or benefit configuration. Direct experience supporting Medicare lines (Medicare Part D and/or MAPD). Understanding of Medicare benefit structures. Experience testing and validating pharmacy benefit configurations in Commercial, Medicaid, Exchange, and/or Medicare lines. Strong knowledge of formulary design, tier structures, utilization management (PA, ST, QL), and accumulator logic. Ability to analyze benefit design documents and translate requirements into executable test scenarios. Strong analytical skills with high attention to detail and accuracy. Proficiency in Microsoft Excel for data review, validation, and reporting. Strong written and verbal communication skills. Experience client‑facing discussions to review benefit testing outcomes and implementation readiness. Salary New York, NY (hybrid): $78,800 - $98,500 Denver, CO (hybrid): $72,000 - $90,000 Remote: $62,400 - $90,000 Benefits Full‑time employees receive medical, pharmacy, dental, vision, accidental injury, critical illness, hospital indemnity, and flexible spending accounts. Additional benefits include a health savings account, voluntary life and accidental death and dismemberment insurance, basic life and accidental death coverage, paid time off, sick time, holidays, short‑term and long‑term disability, employee assistance and wellness programs, and a 401(k) plan with company match after one year. Equal Opportunity Statement Capital Rx values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to 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. All employees are responsible for adherence to the Capital Rx Code of Conduct, including reporting of non‑compliance. #J-18808-Ljbffr Judi Health