Senior Manager Government Program Operations (Exchange)

About Judi Health 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 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 Hybrid (Local to Denver, CO, NYC area or Charlotte, NC) Position Summary The Senior Manager, Government Programs Operations is responsible for implementation, operational oversight, and change management of regulatory requirements for Exchange lines of business. The role leads delivery of regulatory reporting, claims operations support, audit readiness, and client deliverables, ensuring compliance with federal and state requirements. Position Responsibilities Lead Government Programs support for Exchange operations, including claims adjudication, regulatory reporting, and audit support (Government and Client) Oversee day‑to‑day operational performance, ensuring alignment with contractual, regulatory requirements, and client expectations Lead the interpretation, implementation, and monitoring of federal and state regulatory requirements impacting Exchange lines of business Collaborate cross‑functionally with Claims, Product, Technology, Compliance, and Legal SMEs to assess regulatory impacts and ensure timely, coordinated implementation of required changes Design, document, and scale operational processes that enable accurate, compliant, and efficient service delivery Define business and system requirements to support compliant claims processing, data accuracy, and reporting outcomes Lead regulatory reporting activities and ensure completeness, accuracy, and timeliness of all required submissions Support internal and external audits by federal and state agencies, including audit preparation, documentation, issue response, and remediation tracking Monitor Exchange program operations to identify and resolve issues, including root‑cause analysis and implementation of corrective actions Partner with stakeholders to manage error handling, operational exceptions, and process improvements across claims and reporting functions Identify opportunities to enhance operational performance, compliance, and scalability through process improvement and innovation Own and maintain documentation of policies and procedures, reporting specifications, job aids, and workflows for Government Programs Operations Maintain current knowledge of Exchange regulatory requirements and market trends to support compliance and strategic decision‑making Provide data‑driven insights to improve operational effectiveness, reporting accuracy, and overall program performance Foster a high‑performance culture through mentoring, collaboration, and ongoing performance feedback Assess impact of new business and regulatory changes to ensure appropriate scalability, resource planning, and organizational readiness Required Qualifications 6+ years of relevant Prescription Benefit Management and/or Health Plan experience supporting Exchange programs 5+ years people management experience Subject‑matter expertise of Exchange regulatory requirements and associated product and/or operational workflows Demonstrated experience supporting regulatory reporting, audits, and compliance activities Extremely flexible, highly organized, and able to shift priorities easily in a fast‑paced environment Attention to detail and commitment to delivering high‑quality work product Excellent written and verbal communication skills Proven success managing cross‑functional teams and maintaining effective relationships at all levels, including government entities Strong operational mindset with experience improving processes and driving execution Ability to translate regulatory guidance into business and system requirements Strong analytical skills and experience leveraging data to support decision‑making Salary Range

NY: $155,000 – $165,200 USD

Denver, CO: $14,500 – $155,000 USD Charlotte, NC: $137,600 – $145,000 USD EEO Statement Judi Health values a diverse workplace and celebrates the diversity that each employee brings. We provide equal employment opportunities 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. #J-18808-Ljbffr Capital Rx