Location: Remote (For Non-Local) or Hybrid (Local to NYC area)
Position Responsibilities
Support implementation and client management teams with all day-to-day client requirements
Responsible for timely and accurate management and execution of all client benefit requests, including benefit changes, eligibility changes, and new implementations
Analyze incoming client requests and work with internal and external teams to complete required plan documentation
Support implementation of new plans, pricing, and networks, consistent with strategic or administrative intent
Lead pre- and post-implementation quality assurance and testing to validate coding accuracy
Lead claim reviews to proactively identify discrepancies or inaccuracies and develop solutions to address
Handle and resolve sponsor and member issues, escalating as needed
Research and respond to claims processing and system configuration inquiries
Coordinate integration of other data inputs into client management processes
Collaborate cross functionally to support general client operations, as required
Required Qualifications
Bachelor’s Degree preferred, or equivalent combination of education, training, and experience
2+ years of proven experience in PBM / health plan, benefits consulting, or healthcare
Health Plan experience required
Track record of building trusting internal and external relationships
Track record of leading cross-functional initiatives, driving high performance, meeting deadlines, and executing on deliverables
Medicaid experience required
Experience working with structured and unstructured data
Proficient in Microsoft Office, SQL a bonus
Ability to balance multiple complex projects simultaneously
Exceptional written and verbal communication skills
Extremely flexible, highly organized, and able to shift priorities easily
Attention to detail & commitment to delivering high quality work product
Base Salary: $80,000 - $95,000
This range represents the low and high end of the anticipated base salary range for the NY - based position. The actual base salary will depend on several factors such as: experience, knowledge, and skills, and if the location of the job changes.
About Capital Rx
Capital Rx is a full-service pharmacy benefit manager (PBM) and pharmacy benefit administrator (PBA), advancing our nation’s electronic healthcare infrastructure to improve drug price visibility and patient outcomes. As a Certified B Corp™, Capital Rx is executing its mission through the deployment of JUDI®, the company’s cloud-native enterprise health platform, and a Single-Ledger Model™, which increases visibility and reduces variability in drug prices. JUDI connects every aspect of the pharmacy ecosystem in one efficient, scalable platform, servicing millions of members for Medicare, Medicaid, and commercial plans. Together with its clients, Capital Rx is reimagining the administration of pharmacy benefits and rebuilding trust in healthcare.
Capital Rx 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.
Seniority level
Entry level
Employment type
Full-time
Job function
Management and Manufacturing
Industries
Hospitals and Health Care
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