Government Program Operations Specialist

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.

Together with our clients, we're rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit

Location: Remote (For Non-Local) or Hybrid (Local to Denver or NYC area)

Position Summary:

TheGovernment Programs Operations Specialistis a hands-on position responsible forcoordinatingthe day-to-day operations and activitiesof the Government Programs Operationsteam. This position providesthe candidateacareer growthopportunitywhilelearningaboutMedicare Part D,Medicaidand Exchange business.

Position Responsibilities:

• Manage the Government Programs Operations team shared Outlook mailbox, including but not limited to timely, accurate and complete responses, and ensuring timeframes for deliverables.
• Lead and execute pharmacy outreach initiatives related to CMS disputes, ensuring compliance with regulatory requirements and internal Government Operations procedures while applying judgment in communication strategy and issue resolution
• Serve as a key contributor in the validation of system enhancements, including evaluating output data,identifyingdiscrepancies, and providing recommendations to improve system performance and data integrity.
• Design,maintain, and continuously improve structured documentation frameworks, including job aids, policies and procedures (P&Ps), standard operating procedures (SOPs), and training materials to support operational consistency and scalability.
• Develop andoptimizeinternal workflows and job aids, driving process standardization andidentifyingefficiency opportunities across Government Programs Operations.
• Oversee daily PDE reconciliation activities, analyzing trends,identifyingvariances, and proactively addressing discrepancies to ensure data accuracy and compliance.
• Manage and resolve escalations arising from claims monitoring activities by applying critical thinking, root cause analysis, and cross-functional collaboration.
• Support strategic Government Programs Operations initiatives, contributing insights, process improvements, and subject matterexpertiseas assigned.
• Plan, coordinate, andfacilitatecross-functional meetings to drive alignment, resolve issues, and advance operationalobjectives.
• Collaborate closely with Government Programs Operations team members and business partners to address operational needs, improve processes, and support broader organizational goals.

Required Qualifications:

• 3+ years of experience in an equivalent role
• High school diplomarequired
• Experience with Medicare Part D and/or Pharmacy Technician experiencepreferred
• Organizational skills and a very keen eye for detail and accuracy.
• Experience working in high-growth, startup environments - an advantage.
• A positive and upbeat attitude, and excellent interpersonal communication skills.
• A commitment to deliveringa high levelof customer service, both internally and externally.
• Flexibility to respond to a range of different work situations.
• An ability to work under pressure and juggle multiple priorities at any given time.
• An ability to work well independently and be an effective collaborator within and across teams.

This range represents the low and high end of the anticipated base salary range. The actual base salary will depend on several factors such as: experience, knowledge, skills, and location of the job.

Remote, US Salary Range $69,200—$100,000 USD New York, NY Salary Range $87,200—$109,000 USD Denver, CO Salary Range $80,000—$100,000 USD

All employees are responsible for adherence to the Capital Rx 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.

Judi Health 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.

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