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 www.judi.health.

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

Position Summary:

The Government Programs Operations Specialist is a hands-on position responsible for coordinating the day-to-day operations and activities of the Government Programs Operations team. This position provides the candidate a career growth opportunity while learning about Medicare Part D, Medicaid and 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, identifying discrepancies, 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 and optimize internal workflows and job aids, driving process standardization and identifying efficiency opportunities across Government Programs Operations. 
• Oversee daily PDE reconciliation activities, analyzing trends, identifying variances, 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 matter expertise as assigned. 
• Plan, coordinate, and facilitate cross-functional meetings to drive alignment, resolve issues, and advance operational objectives. 
• Collaborate closely with Government Programs Operations team members and business partners to address operational needs, improve processes, and support broader organizational goals. 

Required Qualifications: <