Analyst, Data Exchange - Claims Operations

Judi Health is a health technology company providing benefit administration solutions through a unified claims processing platform. The Data Exchange Analyst supports the accuracy, reliability, and operation of pharmacy benefit data feeds, including claims, eligibility, formulary, and network reporting. The role also involves troubleshooting data issues, supporting integrations and historical data loads, collaborating with cross-functional teams, and improving operational processes.

Responsibilities

• Develop, validate, and maintain outbound data feeds (claims, formulary, network, eligibility) to ensure accuracy and alignment with JUDI Rx standards
• Assist in setting up and testing data connectivity for new and existing clients
• Support manual claims processing activities, including error resolution and specialized claim scenarios, as directed by the Data Exchange leadership team
• Execute and support historical data loads and related data preparation tasks
• Investigate, troubleshoot, and resolve data transfer and loading issues, partnering with internal teams and external integration partners
• Monitor system status, dashboards, and data movement to detect anomalies or trends that may impact data quality or timeliness
• Ensure all issues are resolved in accordance with established procedures, quality standards, and defined SLAs
• Perform regular audits and data reconciliations to validate accuracy across JUDI and downstream systems
• Work collaboratively with Client Operations, Implementation, Product, and Development teams to support onboarding, migrations, vendor changes, and data‑related client requests
• Act as a liaison to ensure clear communication of data requirements, issue status, and impacts across internal stakeholders
• Translate business needs into clear data requirements or configuration updates, escalating complexity or risks to leadership as appropriate
• Recommend opportunities for process automation, quality improvement, and enhanced efficiency within the Data Exchange function
• Create and update process documentation, SOPs, and configuration guidelines to support the consistency of JUDI operational workflows
• Contribute to internal knowledge sharing and support training efforts for new team members
• Maintain awareness of Medicare, Medicaid, and state regulatory requirements related to data exchange and ensure adherence to all compliance standards
• Follow all JUDI Rx data governance practices, HIPAA guidelines, and security protocols
• Adhere to the JUDI Rx Code of Conduct, including timely reporting of potential noncompliance

Preferred

• Proficiency in SQL, Excel, and other data manipulation tools preferred
• Experience working with data feeds, EDI, or system integrations strongly preferred
• SQL
• Excel
• Data manipulation
• Data feeds
• EDI
• System integrations

Benefits

• Hybrid 3 days (offices in NYC, Denver, CO and Charlotte, NC area)

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

• Bachelor's degree required
• 1+ years of experience in PBM, healthcare data operations, or IT integration roles
• Strong understanding of PBM data (eligibility, claims, accumulators, formulary, network) and file layouts
• Strong analytical and root‑cause problem‑solving skills
• Strong communication skills with the ability to collaborate across technical and business teams
• Detail‑oriented, self‑motivated, and able to manage multiple priorities in a fast‑paced environment
• Proficiency in SQL, Excel, and other data manipulation tools preferred
• Experience working with data feeds, EDI, or system integrations strongly preferred
• 1+ years of experience in PBM, healthcare data operations, or IT integration roles.

Required skills

• Electronic Data Interchange (EDI), Pharmacy Benefit Management (PBM) Data, Root-Cause Problem Solving, SQL, System Integrations

Experience

• 1+ years