Operations Analyst, Government Programs (EGWP)

Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. The Government Programs Operations Analyst (EGWP) provides operational and administrative support to ensure day to day Health Plan activities are performed timely and compliantly, focusing on Medicare Part D and EGWP implementation and oversight.

Responsibilities

• Support EGWP program setup, implementation and go-live readiness across assigned internal functions and delegate oversight, which includes enrollment, claims processing, member services, member communications, CAHPS activities and associated member service STARs activities
• Monitor daily, weekly and monthly performance, operational KPIs and CMS compliance metrics for enrollment, member services, and member communications
• Support with issue resolution and corrective action completion with related, first tier and downstream entities (FDRs)
• Perform oversight of monthly enrollment audits performed by CMS and semi-annual enrollment reporting
• Perform oversight of member services and member communications through call evaluations and random sample review or materials and documentation
• Ensure timely and accurate reporting information is received from both internal and external resources as required by the Health plan
• Collaborate with account management and/or employer groups on enrollment issues to be resolved by Employer groups to ensure timeliness and compliance with CMS guidance
• Develop compliant documentation for operational areas to include policies, procedures, workflows and other work instructions
• Support additional functions, as needed

Preferred

• Health Plan Medicare Part D and/or EGWPs
• Experience working within CMS systems, including but not limited to HPMS and MARx
• Experience with Federal and State Audits
• Health Plan Medicare Part D
• CMS systems experience
• HPMS proficiency
• MARx proficiency
• Federal Audits experience
• State Audits experience

Company

• Health benefit administration platform for employers, unions, and plans
• New York, New York, USA
• https://www.judi.health/
• Founded in 2017
• 501-1000 employees

Qualifications

• Minimum of HS diploma/GED or equivalent experience
• 3+ years of Medicare Part D and/or EGWP experience
• Experience with Medicare Part D enrollment, call center and member communication requirements and reporting
• Experience working in a delegated and highly matrixed organization
• Strong operational acumen
• Strong analytical acumen
• Health Plan Medicare Part D and/or EGWPs
• Experience working within CMS systems, including but not limited to HPMS and MARx
• Experience with Federal and State Audits

Required skills

• CMS compliance, Employer Group Waiver Plan (EGWP), Federal and State Audits, HPMS, MARx, Medicare Part D, Medicare Part D enrollment, Operational acumen

Preferred skills

• $736M, 2024-03-28, 2025-09-23, 2026-09-04, 2026-09-09, 2026-10-23, AI Tools, Anthony Loiacono, B Capital, CEO & Co-Founder, Chief Administrative Officer, Company data provided by, EIN Presswire, Experience with Federal and State Audits, General Catalyst,Wellington Management, Health Plan Medicare Part D and/or EGWPs, John Nicolosi, Judi Health Launches Medicare Part D Plan for Employers, Key Investors, Late Stage, Leadership Team, MedCity News, New York, New York, USA, Prime Therapeutics, Recent News, Secondary Market· $148M, Series E· $115M, Series F· $252M, Total Funding, https://www.judi.health

Experience

• 3+ years