Position Overview:

The Account Executive/Strategic Account Executive - PBA Services is responsible for managing the planning, execution, growth & retention and client satisfaction of assigned clients in the Pharmacy Benefit Administration (PBA) market segment including Health Plans, Third Party Administrators (TPAs), and other Platform services. Additionally, this position will lead and collaborate through the broader Account Management team and with internal Capital Rx teams/departments as the client voice and advocate to ensure ongoing client satisfaction and to achieve client priorities and contractual obligations.

This position acts as the quarterback and leader of the broader Account Management team who are aligned in support of our clients. This position reports to the Senior Account Executive/Senior Director, PBA Client Services.

Position Responsibilities:

• Work closely with some of our biggest Texas-based clients and manage the complexities of working within a highly-regulated market of the TDI (Texas Department of Insurance)

• Provide oversight and direction to the broader Account Management team with a focus on member and client satisfaction, trend management, client growth & retention, and regulatory compliance to meet client specific objectives, client priorities and service model deliverables

• Lead and develop the client relationship strategy and the strategic business planning process across the clients in your portfolio while incorporating other internal staff where and when needed to build and foster relationships with influencers and decision makers.

• Maintain thorough knowledge and tracking of contractual obligations on assigned book of business, including financials, performance guarantees, terms, and reporting/compliance

• Manage and facilitate the Account renewal and contracting process with a focus on client retention and the client financial/PNL management

• Serve as the relationship lead on assigned book of business, incorporating other internal staff where and when needed to the relationship; build and foster relationships with influencers and decision makers at the client

• Anticipates customer needs and proactively identifies new opportunities within assigned accounts.

• Develop and maintain comprehensive knowledge of our business, including products and services to field questions from the client side and to answer timely & accurately

• Collaborate with internal teams to customize offerings and solutions, aligning with Health Plan/TPA Account needs and market demands - assemble internal resources to overcomes challenges.

• Analyze and interpret current pharmacy and healthcare trends, competitor activities, and industry regulations to inform strategic decisions, provide proactive recommendations for plan management and enhance the company's positioning within the PBA Services segment

• Lead, coach and support the Account Team on the effective positioning of the Capital Rx value proposition, our suite of Capital Rx Products and Solutions and JUDI capabilities available to our PBA clients

• Partner with our Business Development, Underwriting Teams & Senior Account Executives to support our PBA Account level growth and retention efforts by providing with Capital Rx sales support and market differentiator positioning, including RFP support, Broker/Consultant engagement and Best & Final support for prospective, existing and new and client business development needs

• Provide ongoing direction, coordination and coaching to the broader Account Team to align the Account Team understanding of the assigned client(s) business lines, strategies, key stakeholders & decision makers and priorities

• Serve as the content expert for Health Plan/TPA clients & opportunities

• Identify and help contribute to process improvement efforts

• Be accountable & own the client end-to end, inclusive of service model deliverables, contractual negotiations, client escalations and PNL management.

• All employees are responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance.

Required Qualifications:

• Bachelor’s or advanced degree in health administration, business, or relevant professional experience. Bachelor of Pharmacy (B.S. Pharmacy) or Doctor of Pharmacy (PharmD) degree from an accredited institution is a plus

• Relevant professional experience for at least five (5) years in pharmacy – working within a health plan, managed care, or pharmacy benefits management (PBM) focused on Health Plans and Payer Commercial (Insured, Self-Funded, Exchange) and Government Program (Medicare & Medicaid) business lines. Health plan industry experience highly preferred

• Market and operational knowledge of Medicare Part D, Medicaid and Health Exchange pharmacy is required along with experience in supporting highly regulated business lines

• Track record of building trust in internal and external relationships

• Solution-focused problem solving and client positioning skills

• Exceptional written and verbal communication skills

• Ability to work with and influence peers in a team effort; leading cross-functional initiatives, meeting deadlines, and executing on deliverables while building strong internal relationships

• A decisive individual with sound technical skills, analytical ability, good judgement, and strong operational focus and detail-oriented perspective

• Flexible, highly organized, and able to shift priorities easily and work independently to meet deadlines

• Ability to effectively work with peers in a team effort

• Proficient in Microsoft Office Suite with emphasis on Microsoft Excel and large data sets and other industry software programs

• Ability to travel and present to small and large groups; travel is estimated to be up to 25% and be variable by season and business cycle

Preferred Qualifications:

• Experience working with clients who are subject to TDI (Texas Department of Insurance) rules and regulations

#LI-BC1

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

About Capital Rx:

Capital Rx is a full-service pharmacy benefit manager (PBM) overseeing prescription benefit plans on behalf of employers, unions, and government entities in the commercial space and provides Pharmacy Benefit Administration (PBA) services to Health Plans and TPAs.  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. 

Position Overview:

The Account Executive/Strategic Account Executive - PBA Services is responsible for managing the planning, execution, growth & retention and client satisfaction of assigned clients in the Pharmacy Benefit Administration (PBA) market segment including Health Plans with multiple lines of businesses, Third Party Administrators (TPAs), commercial employer groups, and other Platform services.  Additionally, this position will lead and collaborate through the broader Account Management team and with internal Capital Rx teams/departments as the client voice and advocate to ensure ongoing client satisfaction, retention, and to achieve client priorities and contractual obligations.

This position acts as the quarterback and leader of the broader Account Management team who are aligned in support of our clients. This position reports to the Senior Director, PBA Client Services.

Position Responsibilities:

• Provide oversight and direction to the broader Account Management team with a focus on client satisfaction, trend management, client growth & retention, and regulatory compliance to meet client specific objectives, client priorities and service model deliverables
• Lead and develop the client relationship strategy and the strategic business planning process across the clients in your portfolio while incorporating other internal staff where and when needed to build and foster relationships with influencers and decision makers
• Maintain thorough knowledge and tracking of contractual obligations on assigned book of business, including financials, performance guarantees, terms, and reporting/compliance
• Manage and facilitate the Account renewal and contracting process with a focus on client retention and the client financial/PNL management
• Serve as the relationship lead on assigned book of business, incorporating other internal staff where and when needed to the relationship; build and foster relationships with influencers and decision makers at the client
• Anticipates customer needs and proactively identifies new opportunities within assigned accounts
• Develop and maintain comprehensive knowledge of our business, including products and services to field questions from the client side and to answer timely & accurately
• Collaborate with internal teams to customize offerings and solutions, aligning with Health Plan/TPA Account needs and market demands - assemble internal resources to overcomes challenges 
• Analyze and interpret current pharmacy and healthcare trends, competitor activities, and industry regulations to inform strategic decisions, provide proactive recommendations for plan management and enhance the company's positioning within the PBA Services segment
• Lead, coach and support the Account Team on the effective positioning of the Capital Rx value proposition, our suite of Capital Rx Products and Solutions and JUDI capabilities available to our PBA clients
• Partner with our Business Development & Underwriting Teams to support our PBA Account level growth and retention efforts by providing Capital Rx sales support and market differentiator positioning, including RFP support, Broker/Consultant engagement and Best & Final support for prospective, existing and new and client business development needs
• Provide ongoing direction, coordination and coaching to the broader Account Team to align the Account Team understanding of the assigned client(s) business lines, strategies, key stakeholders & decision makers and priorities
• Serve as the content expert for Health Plan/TPA clients & opportunities
• Identify and help contribute to process improvement efforts
• Be accountable & own the client end-to end, inclusive of service model deliverables, contractual negotiations, client escalations and PNL management.
• All employees are responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance.

Required Qualifications:

• Bachelor’s or advanced degree in health administration, business, or relevant professional experience. Bachelor of Pharmacy (B.S. Pharmacy) or Doctor of Pharmacy (PharmD) degree from an accredited institution is a plus
• Relevant professional experience for at least five (5) years in pharmacy – working within a health plan, managed care, or pharmacy benefits management (PBM) focused on Health Plans and Payer Commercial (Insured, Self-Funded, Exchange) and Government Program (Medicare & Medicaid) business lines.  Health plan industry experience preferred
• Market and operational knowledge of Medicare Part D, Medicaid and Health Exchange pharmacy is a plus along with experience in supporting highly regulated business lines
• Track record of building trust in internal and external relationships
• Solution-focused problem solving and client positioning skills
• Exceptional written and verbal communication skills
• Ability to work with and influence peers in a team effort; leading cross-functional initiatives, meeting deadlines, and executing on deliverables while building strong internal relationships
• A decisive individual with sound leadership and technical skills, analytical ability, good judgement, and strong detail-oriented perspective
• Flexible, highly organized, and able to shift priorities easily and work independently to meet deadlines
• Ability to effectively work with peers in a team effort
• Proficient in Microsoft Office Suite with emphasis on Microsoft Excel and large data sets and other industry software programs
• Ability to travel and present to small and large groups; travel is estimated to be up to 25% and be variable by season and business cycle.

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

Position Summary:

Join our mission to transform our nation's healthcare system as a Senior Full-stack Software Developer. In this role you will assist in leading projects from design to delivery. Partner with product managers and designers to define requirements during discovery and planning. Collaborate with developers to deliver those requirements on time as new features or improvements to existing functionality. 

Why You’ll Love Working Here 

• We have a remote-first culture.
• You will make a tangible impact on society. Your code will directly improve healthcare experiences for millions.
• We are a late-stage startup with stability. We have startup energy with a focus on delivery, but healthy processes with a strong financial outlook that provides a sense of security. 

Position Responsibilities

In this role, you’ll combine technical leadership with hands-on coding to build scalable, high-impact healthcare technology. You will: 

• Exercise leadership over features from design to delivery. 
• Be a partner to product, design, and quality assurance team members. 
• Become a subject matter expert on your team’s products. 
• Provide technical support to cross-functional team members and stakeholders. 
• Expand Judi, our web-based enterprise health platform, using Python, AWS services, React/Typescript, and other technologies. 
• Work in an Agile/Scrum environment. 
• Code of Conduct: Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance. 

Preferred Qualifications

We’re looking for someone who brings a mix of technical expertise, problem-solving ability, and collaborative spirit: 

• 7+ years of job-related experience. 
• Desire to work at a health tech company. 
• Strong Python (Flask / SQLAlchemy) and React / Typescript experience. 
• Advanced PostgreSQL database knowledge (e.g., common table expressions, windowing functions, views, stored procedures, full-text or geospatial indexing). 
• Experience with infrastructure as code using AWS, Terraform, or similar technologies. 
• Experience writing unit and integration tests. 
• Git expertise and experience working in a mono repo. 
• Able to demonstrate agency, urgency, and ownership over delivering quality work. 
• Strong written and verbal communication skills. 
• Previous Pharmacy Benefits Manager (PBM) experience is a plus. 

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.

Location: Hybrid (Local to NYC area)

About the team

The Platform team at Capital Rx is made up of a set of passionate, motivated, and driven individuals who are not only experts in technologies but are great problems solvers and brings high energy and inspiration every day. The team always works a sense of ownership and urgency delivering highest quality of work ensuring seamless operations and fostering collaboration across the software engineering department. We own the architecture, framework & standards, infrastructure and CI/CD pipelines which development teams utilize to deliver code to Captial Rx’s Judi® platform. The team is also responsible for the production environment which requires knowledge with monitoring, alerting and on-call practices. The Platform team performs many functions whether that is tactical operations, providing general solutions for the enterprise or giving guidance or recommendations for individual product teams.

Position Summary:

We are a rapidly growing late-stage health tech company helping millions of lives through our innovative product Judi. We’re seeking a highly skilled and experienced Senior Platform Developer II to join our platform team. This pivotal role will be instrumental in building, scaling, and maintain the robust and secure infrastructure that powers our mission-critical platform.

You will be a force multiplier, enabling our development teams to deliver features faster and more reliably. You will champion infrastructure-as-code principles, contribute code to platform scalability, drive automation across the entire software development lifecycle, and ensure our platform meets the highest standards of scalability, performance, and security.

Position Responsibilities:

• Architect, implement, and maintain highly available, scalable, and secure platform & infrastructure
• Develop and maintain robust automation pipelines for continuous delivery (CI/CD), and infrastructure provisioning tools like GoCD, Harness, and Terraform
• Write clean, efficient, and well-tested Python code for automation, tooling and service development.
• Manage and optimize relational or in-memory databases, including PostgreSQL, Redshift and Redis, ensuring high performance, reliability, and data integrity.
• Administer and finetune container orchestration platforms such EKS and ECS.
• Implement and manage serverless architectures leveraging AWS Lambda for various platform functionalities.
• Collaborate closely with development teams to ensure infrastructure aligns with application requirements and best practices.
• Lead efforts in defining and enforcing security best practices across the platform, including adherence to HIPAA standards, FISMA, SOC II, and FedRAMP compliance standards.
• Monitor systems performance, identify bottlenecks, and implement proactive solutions to ensure optimal operation and scalability.
• Participate in on-call rotations to provide operational support and incident response.
• Champion Agile/Scrum methodologies, actively participating in sprint planning, stand-ups, and retrospectives.
• Mentor junior developers and contribute to a culture of technical excellence and continuous improvement.
• Evaluate and recommend new technologies and tools to enhance platform capabilities and efficiency.
• Develop internal tooling and automation scripts using Python and work with SQL to support operational workflows.
• Implement observability (monitoring/logging/alerting) best practices for highly available SaaS services.
• Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance.

Requirements

• 8+ years of experience as a Platform Engineer, DevOps Engineer, or Site Reliability Engineer.
• Deep expertise in AWS infrastructure and services including but not limited to EC2, Lambda, ECS, EKS, RDS, S3, VPC, CloudWatch, SQS, SNS, IAM, Kinesis
• Excellent proficiency with Terraform, Python, SQL, and automation tooling.
• Extensive experience with Docker and container orchestration (Kubernetes/EKS).
• Solid understanding and hands-on experience with SQL, database administration (PostgreSQL preferred), and performance tuning
• Experience with CI/CD systems (e.g., GoCD, GitHub Actions, Harness).
• Proven experience in automating Observability & Monitoring (Grafana, Kibana, Prometheus), standardizing incident response for alerts to maintain SLAs and SLOs
• Hands-on experience in environments compliant with FISMA, SOC 2, and/or FedRAMP.
• Background in building highly scalable, performant SaaS platforms.
• Excellent communication, collaboration and problem-solving skills.
• Ability to work effectively with cross-functional teams, including developers, IT security & compliance, product manager, and scrum masters.
• Strong experience in production on call rotations and responding to alerts.

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.

Position Summary:
Join our mission to transform pharmacy benefits and healthcare navigation as a Senior Fullstack Software Developer. You will lead the delivery of complex, end-to-end features—building responsive, accessible UIs with React/TypeScript/Next.js and implementing reliable Python APIs (FastAPI/Flask with SQL). You’ll partner with product and design to refine requirements, define clear API contracts, and raise the bar on testing, CI/CD, performance, and security (OAuth 2.0/OIDC). 

Position Responsibilities: 

• Lead design and implementation of user-facing features and backend services. 

• Build accessible, performant UIs with TypeScript, React (React Router / Next.js, HTML, and CSS 

• Implement robust REST APIs in Python (FastAPI/Flask); design schemas and write efficient SQL. 

• Define clear API contracts and patterns; ensure consistency across services and UIs. 

• Own quality: automated tests with Jest, React Testing Library, and Playwright; thorough code reviews and documentation. 

• Improve build and release pipelines (Vite/Webpack, GitHub Actions) and support deployments on AWS. 

• Monitor and troubleshoot production issues; drive reliability and performance improvements. 
• Mentor teammates and contribute to planning, estimation, and technical decisions. 

Preferred Qualifications: 

• 6+ years of experience building fullstack web applications, including leading features or projects. 

• Strong expertise with React (React Router / Next.js) and rendering strategies  (CSR/SSR/SSG), TypeScript, HTML, and CSS. 

• Solid backend experience with Python (FastAPI/Flask), REST API design, and SQL/schema design. 

• Hands-on with Jest, React Testing Library, Playwright; CI/CD with GitHub Actions; familiarity with AWS. 

• Understanding of web security and authentication (OAuth 2.0/OIDC) and secure coding practices. 

• Clear communicator who collaborates effectively across product, design, and engineering. 

• Healthcare/HIPAA experience is a plus. 

• Knowledge of Elastic Search. 

Position Summary:

We are seeking a detail-oriented and analytical Manager, Pharmacy Pricing Appeals to join our Provider Relations team. In this role, you will be responsible for managing and resolving the interaction with the pharmacies related to pricing appeals and claims review requests submitted by the pharmacies or internal teams. This includes performing an initial review of the claim and associated pricing, providing the information to internal teams for review, managing any claim adjustments that may be needed, and communicating any necessary information back to the pharmacies. You will play a critical role in ensuring fair reimbursement practices and maintaining strong relationships with pharmacy partners. 

Position Responsibilities:

• Lead the review and improvement of the pharmacy pricing appeal process in coordination with the Analytics team.
• Lead the review and evaluation of the pricing appeal regulatory requirements with the Legal team.
• Manage intake pharmacy pricing appeals or claims reviews from the pharmacies or internal teams via the applicable intake methods required by internal processes and regulations. This involves managing applicable appeal in-boxes and intake methods.
• Evaluate pharmacy-submitted appeals to ensure they meet established criteria and provide the applicable information to the appropriate internal teams for review.
• Receive the internal claim pricing review and respond to the appealing pharmacy with the information.
• Manage the internal process to update any pricing or make claim adjustments as necessary.
• Collaborate with pharmacies and internal teams to reach equitable reimbursement outcomes.
• Provide appeal response information and feedback to the pharmacies as required.
• Provide clear and timely updates to pharmacies and other stakeholders regarding appeal statuses and outcomes.
• Maintain accurate records of appeals and generate reports on trends and discrepancies.
• Lead the development of and manage the claims review process at the NDC level.
• Support other projects as assigned by the Provider Relations team.
• Responsible for adherence to the Capital Rx Code of Conduct, including reporting of noncompliance.

Minimum Qualifications:

• Bachelor’s degree required.
• 5+ yrs. of experience in reviewing claims or payment appeals in healthcare, pharmacy, PBM, or other relevant experience. Such prior experience in a pharmacy pricing appeals role includes experience in managing regular correspondence and communication with pharmacies.
• In-depth knowledge of pharmacy operations and drug pricing.
• Familiarity with PBMs and their role in pharmacy reimbursement.
• Strong analytical and problem-solving skills.
• Strong project management skills.
• Excellent communication and interpersonal abilities.
• Experience with and understanding of pharmacy claims processing, pharmacy adjudication systems, and reimbursement workflows.
• Knowledge of state or federal pricing appeal laws.
• Intermediate level of proficiency with Microsoft Excel, Word, PowerPoint.
• Proven track record of working in a fast-paced environment, managing multiple tasks at once and having a go-get attitude to provide persistent outreach to pharmacy providers to close out contracts and tasks.
• Ability to work independently, track work/projects appropriately and remain on task.
• Strong communication skills with the ability to develop effective working relationships with providers and internal and external stakeholders.

Preferred Qualifications:

• Certification in pharmacy technician or related field is a plus.

Position Summary

Acts as a dedicated specialist responsible for leading administrative and operational tasks to facilitate the execution of clinical programs and clinical initiatives, including but not limited to, triaging incoming calls, conducting outreach, managing and maintaining drug lists, and supporting reporting requirements.

Position Responsibilities:

• Work with the Clinical Programs team to triage incoming clinical programs calls, schedule appointments for consultations and conduct outreaches to prescribers, pharmacies, and members 
• Lead administrative and operational tasks to support the implementation of clinical programs, including but not limited to Capital Rx’s pharmacogenomics, MTM (Medication Therapy Management), lower cost alternative solutions, opioid safety edits, cost containment, and other clinical initiatives as needed
• Manage and maintain drug lists to support operations of clinical programs including periodic drug list maintenance, weekly and quarterly list reviews, and ad-hoc updates
• Support reporting requirements, monitor claims, and ensure communication amongst all stakeholders including internal and external partners
• Identify, document, and effectively communicate issues to appropriate internal stakeholders ensuring customers receive quality care and resolution meets all health and safety standards
• Work collaboratively with internal business and clinical partners to support clinical program initiatives as required
• Ensure customer satisfaction, demonstrate genuine compassion and care, and provide professional customer service in a fast paced, startup environment
• Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and Company policies
• Uphold general business needs and operations as required

Required Qualifications:

• Active, unrestricted pharmacy technician license
• 2+ years of applicable experience in a clinical pharmacy setting PBM, health plan, or related health care experience
• 1+ year of customer service experience with a passion for building customer loyalty through exceptional listening, relationship building, and strong written and verbal communication
• Ability to balance multiple complex projects simultaneously with minimal direction

Preferred Qualifications:

• Medication Therapy Management (MTM) experience preferred
• Proficient in Microsoft Office Suite with emphasis on Microsoft Excel and PowerPoint
• Experience with Confluence, Jira, Tableau, Salesforce
• Highly detail-oriented and analytical
• Bilingual- Spanish preferred

Base Salary: 

• Remote - $60,000 - $70,000 (final salary within this range is determined by the candidate's geographic location and applicable market tier)

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, and skills, and location of the job.

Nothing in this position description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

Benefits

Judi Health provides all full-time and part-time benefit-eligible employees with the ability to elect medical and pharmacy coverage, dental insurance, vision insurance, accidental injury insurance, critical illness insurance, hospital indemnity insurance, and flexible spending accounts. Full-time employees also have access to a health savings account, voluntary life insurance, and voluntary accidental death and dismemberment insurance for themselves and their eligible dependents.

Judi Health provides full-time employees with the following benefits at no cost to the employee: basic life insurance, basic accidental death and dismemberment insurance, paid time off, sick time, holidays, short-term disability, long-term disability, an employee assistance program, and a wellness program. Full-time employees are also eligible for a 401(k) plan with company match after one year of full-time employment.

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.

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.

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

About the team

The Platform team at Capital Rx is made up of a set of passionate, motivated, and driven individuals who are not only experts in technologies but are great problems solvers and brings high energy and inspiration every day. The team always works a sense of ownership and urgency delivering highest quality of work ensuring seamless operations and fostering collaboration across the software engineering department. We own the architecture, framework & standards, infrastructure and CI/CD pipelines which development teams utilize to deliver code to Captial Rx’s Judi® platform. The team is also responsible for the production environment which requires knowledge with monitoring, alerting and on-call practices. The Platform team performs many functions whether that is tactical operations, providing general solutions for the enterprise or giving guidance or recommendations for individual product teams.

Position Summary:

We are a rapidly growing late-stage health tech company helping millions of lives through our innovative product Judi. We’re seeking a highly skilled and experienced Platform Developer to join our platform team. This pivotal role will be instrumental in building, scaling, and maintain the robust and secure infrastructure that powers our mission-critical platform.

You will be a force multiplier, enabling our development teams to deliver features faster and more reliably. You will champion infrastructure-as-code principles, contribute code to platform scalability, drive automation across the entire software development lifecycle, and ensure our platform meets the highest standards of scalability, performance, and security.

Position Responsibilities:

• Develop and support highly available, scalable, and secure platform & infrastructure
• Develop and maintain robust automation pipelines for continuous delivery (CI/CD), and infrastructure provisioning tools like GoCD, Harness, and Terraform
• Write clean, efficient, and well-tested Python code for automation, tooling and service development.
• Manage and optimize relational or in-memory databases, including PostgreSQL, Redshift and Redis, ensuring high performance, reliability, and data integrity.
• Administer and finetune container orchestration platforms such EKS and ECS.
• Implement and manage serverless architectures leveraging AWS Lambda for various platform functionalities.
• Collaborate closely with development teams to ensure infrastructure aligns with application requirements and best practices.
• Contribute to defining and enforcing security best practices across the platform, including adherence to HIPAA standards, FISMA, SOC II, and FedRAMP compliance standards.
• Monitor systems performance, identify bottlenecks, and implement proactive solutions to ensure optimal operation and scalability.
• Participate in on-call rotations to provide operational support and incident response.
• Adopt Agile/Scrum methodologies, actively participating in sprint planning, stand-ups, and retrospectives.
• Evaluate and recommend new technologies and tools to enhance platform capabilities and efficiency.
• Develop internal tooling and automation scripts using Python and work with SQL to support operational workflows.
• Implement observability (monitoring/logging/alerting) best practices for highly available SaaS services.

Requirements

• 5+ years of experience as a Platform Engineer, DevOps Engineer, or Site Reliability Engineer.
• Strong expertise in AWS infrastructure and services including but not limited to EC2, Lambda, ECS, EKS, RDS, S3, VPC, CloudWatch, SQS, SNS, IAM, Kinesis
• Excellent proficiency with Terraform, Python, SQL, and automation tooling.
• Extensive experience with Docker and container orchestration (Kubernetes/EKS).
• Solid understanding and hands-on experience with SQL, database administration (PostgreSQL preferred), and performance tuning
• Experience with CI/CD systems (e.g., GoCD, GitHub Actions, Harness).
• Proven experience in automating Observability & Monitoring (Grafana, Kibana, Prometheus), standardizing incident response for alerts to maintain SLAs and SLOs
• Hands-on experience in environments compliant with FISMA, SOC 2, and/or FedRAMP.
• Background in building highly scalable, performant SaaS platforms.
• Excellent communication, collaboration and problem-solving skills.
• Ability to work effectively with cross-functional teams, including developers, IT security & compliance, product manager, and scrum masters.
• Strong experience in production on call rotations and responding to alerts.

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.

About the team

Join our team as a Platform Engineer focused on network architecture and site reliability. In this role, you will own the design and implementation of our cloud network architecture, ensuring our platform is resilient, secure, and scales effectively across multiple AWS accounts, environments, and regions. You'll architect solutions for complex networking challenges like hierarchical CIDR allocation across accounts and integrations, implement disaster recovery and regional redundancy strategies, and establish the reliability practices that keep our healthcare platform running. Working closely with leadership and cross-functional teams, you'll build the foundational infrastructure that supports our rapidly growing platform while ensuring we can handle failures gracefully and recover quickly.

Position Responsibilities:

In this role, you'll own critical infrastructure that ensures platform reliability and scalability. You will:

• Design network architecture: Architect and implement hierarchical CIDR allocation strategies across multiple AWS accounts, environments, and external integrations, ensuring proper subnet organization and IP address management.
• Build multi-region capabilities: Design and implement regional redundancy and multi-region failover strategies to support disaster recovery requirements and improve platform availability.
• Manage cloud networking: Own VPC design, subnets, routing tables, security groups, NACLs, VPC peering, Transit Gateway, and other AWS networking components across our infrastructure.
• Implement disaster recovery: Establish and regularly test disaster recovery procedures, backup strategies, and failover mechanisms to ensure business continuity.
• Evaluate multi-cloud solutions: Assess and prototype solutions across AWS, Azure, GCP, and Oracle Cloud to determine optimal approaches for specific use cases and integrations.
• Monitor platform health: Define and implement platform health indicators, SLIs, SLOs, and monitoring that provide early warning of infrastructure issues and track reliability improvements.
• Ensure security and compliance: Work with security teams to implement network security best practices, maintain compliance requirements (HIPAA, SOC2, FedRAMP), and conduct security reviews.
• Drive infrastructure reliability: Participate in on-call rotations, lead incident response for infrastructure issues, conduct postmortems, and implement improvements to prevent recurrence.
• Automate infrastructure management: Build infrastructure-as-code using Terraform to manage network resources, implement self-service capabilities, and ensure consistency across environments.

Requirements:

• 5+ years of infrastructure engineering, DevOps, or site reliability engineering experience.
• Experience leading projects or teams: Demonstrated ability to lead technical initiatives, drive architectural decisions, or mentor other engineers.
• Extensive AWS expertise: Deep production experience with VPC, subnets, routing, security groups, Transit Gateway, Direct Connect, Route 53, and other AWS networking services.
• Network architecture experience: Proven track record designing and implementing complex network architectures including CIDR planning, subnet design, and multi-account strategies.
• Disaster recovery expertise: Experience designing and testing disaster recovery procedures, backup strategies, and multi-region failover capabilities.
• Infrastructure as code: Strong experience with Terraform for managing cloud infrastructure at scale.
• Site reliability practices: Understanding of SLIs, SLOs, error budgets, incident management, and reliability engineering principles.
• Strong development skills: Proficiency in Python or similar languages for automation and tooling.
• Security mindset: Understanding of network security principles, encryption, IAM, and compliance requirements in regulated industries.

Preferred Qualifications: 

• Multi-cloud experience: Hands-on experience with Azure, GCP, or Oracle Cloud networking and cross-cloud connectivity.
• Rust development experience or interest in learning Rust for infrastructure tooling.
• Advanced AWS certifications: AWS Solutions Architect Professional, AWS Advanced Networking, or similar certifications.
• Container networking: Experience with ECS, EKS, or Kubernetes networking, service mesh, and load balancing.
• Database networking: Understanding of database replication, Aurora Global Databases, and cross-region data synchronization.
• CDN and edge networking: Experience with CloudFront, edge locations, and content delivery optimization.
• Cost optimization: Track record of reducing infrastructure costs while maintaining or improving reliability.
• Previous Pharmacy Benefits Manager (PBM) or healthcare technology experience.

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

Position Responsibilities:

• Provide oversight of commercial clients within the health system, employer, labor/union and public verticals for large/jumbo accounts (approximately >15,000+ lives, subject to fluctuate due to the needs of the business)
• Serve as the relationship liaison on assigned book of business, incorporating internal support where and when needed to the foster relationship with influencers and decision makers at the plan
• Develop relationship strategy plans, with support of clinical account manager and account manager
• Lead strategic reviews (e.g. QBRs), prioritize initiatives and maintain momentum across sales and implementation cycles.
• Support member and client satisfaction execution and net promoter score goals
• Provide deep and approachable trend management recommendations with support of reporting 
• Maintain thorough knowledge of contractual obligations assigned book of business, including financials, performance guarantees, terms, and regulatory/compliance
• Lead client renewal process, including contract management 
• Lead ownership of performance guarantee reporting and maintenance 
• Lead regulatory and compliance components 
• Interpret current pharmacy and healthcare trends, and meet with clients to provide proactive recommendations for plan management; find ways of adding value to the client curating offerings tailored to the client’s specific needs
• Identify and contribute to process improvement efforts across Capital Rx
• Assemble internal resources to overcomes challenges
• Anticipates customer needs and proactively identifies new opportunities within assigned accounts
• Comprehensive knowledge of our business, including products and services. Strong ability to field questions from the client side, answer them and answer them correctly
• Review and advise on JUDI product roadmap to ensure current priorities and milestones will meet the client expectation
• Other duties as assigned
• Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance

Required Qualifications:

• 5+ years’ experience in the healthcare industry and/or pharmacy benefits experience
• Demonstrated experience supporting integrated delivery networks (IDNs), hospital systems, or academic medical centers
• Strong ability to navigate and balance plan sponsor goals (e.g. cost control, benefit design, member experience) with health-system pharmacy objectives (e.g. revenue protection, access, utilization management)
• Experience facilitating consensus among stakeholders with competing incentives, using data, clinical rationale, and contract terms to drive alignment
• Working knowledge of 340B program mechanics
• Understanding of healthcare regulatory considerations impacting health systms and PBM oversight.
• Bachelor’s or advanced degree in health administration, business, or relevant professional experience
• Strong data analysis and presentation skills
• Financial and statistical reporting knowledge and experience
• Ability to exercise considerable judgement, maintain confidentiality, and act in a diplomatic manner
• Travel is estimated to not exceed 25% in the busiest times of year
• Progressive staff management experience
• An educator who is trustworthy and willing to share information and serve as a mentor
• Ability to independently identify, research and resolve issues
• A person who can relate to people at all levels of an organization and possesses excellent communication skills
• An excellent facilitator who is experienced in resolving conflicts between different parties to a dispute
• A decisive individual who possesses a strategic focus as well as an operational, implementation, and detail-oriented perspective
• A strategic planner with sound technical skills, analytical ability, good judgement, and strong operational focus
• A well-organized and self-directed individual who can work with minimal amount of supervision
• Ability to work extended hours, weekends, and holidays pursuant with industry demands
• Proficient in Microsoft Office and industry related software programs

Preferred Qualifications:

• PharmD preferred, but not required
• Project management experience preferred

Location: Denver, CO (Hybrid)

Position Summary:

The IT Help Desk Technician assists in managing our ticketing system, MDM software, and AWS platform while overseeing the onboarding and off boarding IT activities associated with employee profiles.

Position Responsibilities:

• Research end user issues independently, when needed, and document/develop a solution per company standards

• Develop additional MDM automation to facilitate user onboarding

• Identify MDM related company needs and create, configure, test and deploy management of user systems via MDM Software.

• Collaborate with internal partner teams to identify compliance, best practice, or other IT related policy needs within the cross functional existing processes and workflows; identify and present enhancements and deploy solutions to the business.

• Responsible for all onboarding and offboarding related IT activities, including system-wide access, purchasing and retrieving of equipment, upgrades, asset tagging, etc.

• Create Exchange rules to address spam/phishing emails as needed.

• Collaborate with the IT Engineering team to drive systemic improvements to email filtering system.

• Promptly respond to user requests via ticketing system/phone calls/IM

• Assist users with access/system issues

• Write and update documentation for user reference

• Help build and establish procedures for newly established team

• Participate in a Help Desk OnCall schedule (tentatively will be 1 week/month, with potential higher volume at onset as the team grows).

• Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance.

Required Qualifications:

• 2+ Years experience in a Help Desk role (preferably in a medium or larger company)

• A customer-oriented approach to problem resolution

• Experience supporting Mac hardware/OSX in a Help Desk environment

• Experience supporting remote users in a distributed environment

• Experience with Jira Service desk or a similar ticketing system

• Experience with Office 365 suite

• Ability to lift 30 lbs. regularly and up to 50 lbs. occasionally (for NYT “future onsite” roles only)

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.

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

Position Responsibilities:

• Provide oversight of commercial clients within the health system, employer, labor/union and public verticals for large/jumbo accounts (approximately >15,000+ lives, subject to fluctuate due to the needs of the business)
• Serve as the relationship liaison on assigned book of business, incorporating internal support where and when needed to the foster relationship with influencers and decision makers at the plan
• Develop relationship strategy plans, with support of clinical account manager and operations manager
• Support member and client satisfaction execution and net promoter score goals
• Provide deep and approachable trend management recommendations with support of reporting 
• Maintain thorough knowledge of contractual obligations assigned book of business, including financials, performance guarantees, terms, and regulatory/compliance
• Lead client renewal process, including contract management 
• Lead ownership of performance guarantee reporting and maintenance 
• Lead regulatory and compliance components 
• Interpret current pharmacy and healthcare trends, and meet with clients to provide proactive recommendations for plan management; find ways of adding value to the client curating offerings tailored to the client’s specific needs
• Identify and contribute to process improvement efforts across Capital Rx
• Assemble internal resources to overcomes challenges
• Anticipates customer needs and proactively identifies new opportunities within assigned accounts
• Comprehensive knowledge of our business, including products and services. Strong ability to field questions from the client side, answer them and answer them correctly
• Review and advise on JUDI product roadmap to ensure current priorities and milestones will meet the client expectation
• Other duties as assigned
• Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance

Required Qualifications:

• 5+ years’ experience in the healthcare industry and/or pharmacy benefits experience
• Bachelor’s or advanced degree in health administration, business, or relevant professional experience
• PharmD preferred, but not required
• Exceptional business acumen skills 
• Strong clinical knowledge and expertise 
• Strong data analysis and presentation skills
• Financial and statistical reporting knowledge and experience
• Project management experience preferred
• Ability to exercise considerable judgement, maintain confidentiality, and act in a diplomatic manner
• Travel is estimated to not exceed 25% in the busiest times of year
• Progressive staff management experience
• An educator who is trustworthy and willing to share information and serve as a mentor
• Ability to independently identify, research and resolve issues
• A person who can relate to people at all levels of an organization and possesses excellent communication skills
• An excellent facilitator who is experienced in resolving conflicts between different parties to a dispute
• A decisive individual who possesses a strategic focus as well as an operational, implementation, and detail-oriented perspective
• A strategic planner with sound technical skills, analytical ability, good judgement, and strong operational focus
• Ability to work with peers in a team effort
• Demonstrated ability to manage multiple priorities and deadlines
• Ability to work extended hours, weekends, and holidays pursuant with industry demands
• Proficient in Microsoft Office and industry related software programs

Position Summary

The Pharmacy Value Programs Senior Project Manager will lead the development, execution, and continuous improvement of innovative pharmacy benefit cost‑savings programs across all lines of business, including Commercial, Exchange, Medicare, and Medicaid. In this highly cross‑functional role, the Program Manager partners closely with internal teams, external vendors, and pharmacy partners to design and implement strategic initiatives—from specialty pharmacy partnerships to benefit design optimization and manufacturer‑direct solutions—that reduce overall drug spend while maintaining or enhancing member experience. This role is responsible for maintaining detailed implementation plans, operational workflows, and training materials while ensuring program quality and compliance through structured audits and documentation. The Project Manager also collaborates with Analytics to produce opportunity assessments and savings reporting, and supports the commercialization of new offerings through pricing, marketing enablement, and RFI/RFP contributions. The ideal candidate brings deep experience in healthcare cost management, strong analytical capabilities, exceptional communication skills, and a strategic mindset with the ability to identify inefficiencies and drive long‑term product and process improvements in a fast‑paced environment.

Position Responsibilities:

• Program Development & Management: Collaborate with key stakeholders to develop and maintain new and existing drug cost containment programs for all lines of business (Commercial, Exchange, Medicare, and Medicaid). Programs include, but are not limited to, partnerships with innovative mail & specialty pharmacies, benefit design optimization, and integration with manufacturer direct offerings.
• Program Planning and Execution: Engage with appropriate stakeholders and cross-functional teams to ensure successful implementation and execution of programs.
• Program Maintenance: Regularly update and maintain comprehensive implementation plans, workflow guides, trainings, and other documentation.
• Quality Assurance: Implement quality control processes to ensure program compliance with established standards and guidelines. Conduct and document audits and work with appropriate stakeholders to implement corrective actions as needed.
• Vendor management: Own relationships with and provide oversight of third-party vendors (including pharmacies) to administer programs with emphasis on member experience and cost savings.
• Data Analytics & Reporting: Use reporting tools and partner with our Analytics team to develop and maintain opportunity analyses and ongoing savings performance reporting.
• Commercialization: Support the go-to-market strategy of savings product offerings including pricing, marketing, and implementation. Support RFI and RFP submissions.
• Continuous quality improvement: Evaluate evolving industry and market landscape and analyze prescription claims data to identify opportunities for improving existing products and developing new products. Supports quality improvement programs/projects as required. 

Required Qualifications:

• Bachelor’s Degree required
• 4+ years of experience applicable to health care cost management, such as in a health plan, PBM, value-based care, or managed care environment; consulting, advising, or tech enablement focused on the preceding areas also considered applicable
• Ability to balance multiple complex projects simultaneously with minimal direction
• Great time-management and organizational skills to manage multiple active projects simultaneously
• Exceptional written, verbal, and presentation skills
• Experience working with data reporting tools, conducting data analyses, and effectively consuming/interpreting data reports and visualizations

Preferred Qualifications:

• Master’s Degree in relevant field (PharmD, MBA, MHA/MHP, etc.)
• Experience with prescription drug channels and payment workflows (pharmacy reimbursement, rebate administration and GPO relations, regulatory requirements, etc.)
• Experience with health insurance or health benefits administration (pharmacy benefits in particular)
• Strong experience in developing, implementing, and using data and workflow management technology solutions (e.g., customer relationship management (CRM), Jira/Salesforce, collaborative Excel workbooks in SharePoint, etc.)
• Experience with programming languages relevant to data analytics, such as SQL or Python
• Proficient in Microsoft Office Suite with emphasis on Microsoft Excel and PowerPoint
• Ability to think strategically and identify inefficiencies, develop long-term solutions, and challenge and improve existing processes through automation and redesign
• Highly detail-oriented and analytical
• Ability to travel occasionally as needed for internal, client, and vendor/partner meetings

Position Summary

The Market Access Programs Senior Project Manager will lead the development, execution, and continuous improvement of innovative market access programs across all lines of business, including Commercial, Exchange, Medicare, and Medicaid. In this highly cross‑functional role, the Program Manager partners closely with internal teams, external vendors, and pharmacy partners to design and implement strategic initiatives—from specialty pharmacy partnerships to manufacturer‑direct solutions—that enhance member experience and reduce overall drug spend. This role is responsible for maintaining detailed implementation plans, operational workflows, and training materials while ensuring program quality and compliance through structured audits and documentation. The Project Manager also collaborates with Analytics to produce opportunity assessments and savings reporting, and supports the commercialization of new offerings through pricing, marketing enablement, and RFI/RFP contributions. The ideal candidate brings deep experience in healthcare cost management, strong analytical capabilities, exceptional communication skills, and a strategic mindset with the ability to identify inefficiencies and drive long‑term product and process improvements in a fast‑paced environment.

Position Responsibilities:

• Program Development & Management: Collaborate with key stakeholders to develop and maintain new and existing market access programs for all relevant lines of business. Programs include, but are not limited to, innovative pharmacy network configurations and partnerships with supply chain stakeholders.
• Program Planning and Execution: Engage with appropriate stakeholders and cross-functional teams to ensure successful implementation and execution of programs.
• Program Maintenance: Regularly update and maintain comprehensive implementation plans, workflow guides, trainings, rules sets, and other documentation as relevant and required.
• Quality Assurance: Implement quality control processes to ensure program compliance with established standards and guidelines. Conduct and document audits and work with appropriate stakeholders to implement corrective actions as needed.
• Vendor management: Own relationship with and provide oversight of third-party vendors and/or partners (pharmacy providers or manufacturers) to administer programs with emphasis on member experience and value capture for clients.
• Data Analytics & Reporting: Use reporting tools and partner with our Analytics team to develop and maintain opportunity analyses and ongoing savings performance reporting.
• Commercialization: Support the go-to-market strategy of program offerings including pricing, marketing, and implementation. Support RFI and RFP submissions.
• Continuous quality improvement: Evaluate evolving industry and market landscape and analyze prescription claims data to identify opportunities for improving existing programs and developing new programs and/or partnerships. Supports quality improvement programs/projects as required. 

Required Qualifications:

• Bachelor’s Degree required
• 4+ years of experience applicable to health care,, such as in a health plan, PBM, pharmacy, manufacturer, value-based care, or managed care environment; consulting, advising, or tech enablement focused on the preceding areas also considered applicable
• Ability to balance multiple complex projects simultaneously with minimal direction
• Great time-management and organizational skills to manage multiple active projects simultaneously
• Exceptional written, verbal, and presentation skills
• Experience working with data reporting tools, conducting data analyses, and effectively consuming/interpreting data reports and visualizations

Preferred Qualifications:

• Master’s Degree in relevant field (PharmD, MBA, MHA/MHP, etc.)
• Experience with prescription drug channels and payment workflows (pharmacy reimbursement, rebate administration and GPO relations, regulatory requirements, etc.)
• Experience with health insurance or health benefits administration (pharmacy benefits in particular)
• Strong experience in developing, implementing, and using data and workflow management technology solutions (e.g., customer relationship management (CRM), Jira/Salesforce, collaborative Excel workbooks in SharePoint, etc.)
• Experience with programming languages relevant to data analytics, such as SQL or Python
• Proficient in Microsoft Office Suite with emphasis on Microsoft Excel and PowerPoint
• Ability to think strategically and identify inefficiencies, develop long-term solutions, and challenge and improve existing processes through automation and redesign
• Highly detail-oriented and analytical
• Ability to travel occasionally as needed for internal, client, and vendor/partner meetings

Position Responsibilities:

• Lead administrative and operational tasks to support the implementation and operations of clinical programs, including pharmacogenomics, MTM, adherence, opioid safety, concurrent and retrospective drug utilization review, and other initiatives as needed
• Support clinical programs business development needs, including client contracting, vendor management, preparation of opportunity analyses, and program sales support
• Validate program identification and claim files, fax and letter communication proofs, vendor invoices, and client invoices for accuracy on a reoccurring basis
• Generate data outputs and analyze large data sets to monitor program quality and identify enhancement opportunities
• Manage large scale projects to support business needs
• Maintain drug lists to support operations of clinical programs including periodic drug list maintenance, weekly and quarterly list reviews, and ad-hoc updates
• Ensure customer satisfaction, demonstrate genuine compassion and care, and provide professional customer service in a fast-paced environment.
• Uphold general business needs and operations as required

Required Qualifications:

• 2+ years of applicable experience in a clinical pharmacy setting PBM, health plan, or related health care experience
• 1+ years of prior experience in business analysis, project management, or related fields
• Ability to manage multiple complex projects simultaneously with minimal direction
• Proficient in Microsoft Office Suite with emphasis on Microsoft Excel and PowerPoint
• Active, unrestricted pharmacy technician license

Preferred Qualifications:

• Proficient in querying large data sets, and coding languages are a plus
• Experience with Confluence, Jira, Tableau, Salesforce
• Experience with specialty pharmacy, home infusion, and related care coordination services
• Highly detail-oriented and analytical 

Nothing in this position description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

Benefits

Judi Health provides all full-time and part-time benefit-eligible employees with the ability to elect medical and pharmacy coverage, dental insurance, vision insurance, accidental injury insurance, critical illness insurance, hospital indemnity insurance, and flexible spending accounts. Full-time employees also have access to a health savings account, voluntary life insurance, and voluntary accidental death and dismemberment insurance for themselves and their eligible dependents.

Judi Health provides full-time employees with the following benefits at no cost to the employee: basic life insurance, basic accidental death and dismemberment insurance, paid time off, sick time, holidays, short-term disability, long-term disability, an employee assistance program, and a wellness program. Full-time employees are also eligible for a 401(k) plan with company match after one year of full-time employment.

Location: Remote (U.S only)

Position Responsibilities:

• Prepare prior authorization requests received by validating prescriber and member information, level of review, and appropriate clinical guidelines
• Make outbound calls to providers to obtain additional clinical information to ensure substantial clinical information exists to reach a clinical determination for pharmacist review
• Proactively obtains clinical information from prescribers, referral coordinators, and appropriate staff to ensure all aspects of clinical guidelines are addressed for pharmacist review.
• Review and analyze pharmacy claims data for proactive outreach and intervention.
• Identify, document, and escalate provider concerns to the appropriate internal team including various members of the Prior Authorization Team
• Triage phone calls from members, pharmacy personnel, and providers by asking applicable drug and client specific clinical questions.
• Effectively communicate issues and resolutions to members, pharmacy staff, providers, and appropriate internal stakeholders.
• Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and Company policies
• Ensure customer satisfaction, extraordinary customer care, and quality resolution with genuine compassion in a fast paced, startup environment
•  

Required Qualifications:

• 2+ years of pharmacy technician experience in a PBM, health plan, or in another clinical pharmacy setting
• Experience handling prior authorization requests/understanding of prior authorization requirements required
• National Certified Pharmacy Technician (CPhT) license, required
• High school diploma or the equivalent; Associate’s or bachelor’s degree is preferred
• Excellent communication, writing, and organizational skills
• Ability to work independently with minimal supervision, stay productive in a remote, high-volume, metric driven call center environment
• Ability to multi-task and collaborate in a team with shifting priorities

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. 

Nothing in this position description restricts management’s right to assign or reassign duties and responsibilities to this job at any time. 

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: 

• 3+ years of experience in an equivalent role 
• High school diploma required 
• Experience with Medicare Part D and/or Pharmacy Technician experience preferred 
• 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 delivering a high level of 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. 

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

As an Account Manager focused on PBA and Medicare, you'll be at the forefront of delivering seamless client experiences by managing benefit changes, implementing new plans, and ensuring pricing accuracy—all while driving impactful solutions that directly shape business success. You’ll lead key quality assurance initiatives, proactively identify claim discrepancies, and collaborate across teams to streamline processes, making a tangible impact on client satisfaction and operational efficiency. Your expertise will be essential in shaping client strategies, resolving complex issues, and upholding the values that keep Capital Rx ahead of the competition.

Position Responsibilities:

• Partner with clinical account manager (CAM) and account executive (AE) to manage clients through the entire lifecycle from implementation through go-live and renewal on a designated book of business
• Support implementation as a critical member of the 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, override requests, demos 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
• Travel requirements not to exceed 25%
• 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
• Responsible for relationship management and contribution to successful NPS and Account Management Survey results, along with retention support
• Responsible for adherence to the Capital Rx Code of Conduct, including reporting of noncompliance.

Qualifications / Profile:

• Undergraduate bachelor’s degree, with record of strong academic performance
• 5+ years of proven experience in PBM / health plan, benefits consulting, healthcare
• 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
• 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

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

Position Summary

Join our mission to transform our nation's healthcare system as a Senior Backend Software Developer. In this role you will assist in leading projects from design to delivery. Partner with product managers and designers to define requirements during discovery and planning. Collaborate with developers to deliver those requirements on time as new features or improvements to existing functionality. 

Why you’ll love working here

• We have a remote-first culture.
• You will make a tangible impact on society. Your code will directly improve healthcare experiences for millions.
• We are a late-stage startup with stability. We have startup energy with a focus on delivery, but healthy processes with a strong financial outlook that provides a sense of security. 

Position Responsibilities

In this role, you’ll combine technical leadership with hands-on coding to build scalable, high-impact healthcare technology. You will: 

• Exercise leadership over features from design to delivery. 
• Be a partner to product, design, and quality assurance team members. 
• Become a subject matter expert on your team’s products. 
• Provide technical support to cross-functional team members and stakeholders. 
• Expand Judi, our web-based enterprise health platform, using Python, AWS services, and other technologies. 
• Work in an Agile/Scrum environment. 
• Code of Conduct: Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance. 

Minimum Qualifications

We’re looking for someone who brings a mix of technical expertise, problem-solving ability, and collaborative spirit: 

• 7+ years of job-related experience.
• Desire to work at a health tech company.
• Strong Python (Flask / SQLAlchemy) experience.  
• Advanced PostgreSQL database knowledge (e.g., common table expressions, windowing functions, views, stored procedures, full-text or geospatial indexing).
• Experience with infrastructure as code using AWS, Terraform, or similar technologies.
• Experience writing unit tests.
• Git expertise and experience working in a mono repo.
• Able to demonstrate agency, urgency, and ownership over delivering quality work.
• Strong written and verbal communication skills.
• Previous Pharmacy Benefits Manager (PBM) experience is a plus.  

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.

Position Summary:

We are seeking a passionate and driven Product Manager with a strong background in consumer-facing mobile applications to drive the vision, strategy, and roadmap for Judi Health’s member-facing app experiences. This role will focus on building intuitive, high-impact mobile solutions that simplify care navigation, enhance engagement, improve health outcomes, and help lower the overall cost of care.

Position Responsibilities:

• Lead the product strategy, development, and enhancements of Judi Health’s Product offerings
• Develop business requirements and specification documents, working with our operations and client management and sales teams
• Accountable for on-time and accurate delivery of product features.
• Participate in product planning, roadmap development, and long-term strategy planning
• Effectively manage and meet stakeholders’ priorities and expectations.
• Support collecting and acting on feedback from internal stakeholders and external clients to iterate and improve upon existing products and ideate and anticipate new products
• Perform backlog grooming, epic planning, refinement, and other scrum events.
• Perform demos of in-market product to clients and prospects.
• Manage and execute day-to-day project management functions with regards to the specific products currently under development
• Analyze product data to derive insights to assist in the prioritization and post release optimization of the products
• Work with design team to conduct user experience testing and research
• Conduct user testing of prior to release to the customer.
• Support general business needs, as required
• Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance

Required Qualifications:

• Bachelor’s degree, Masters Preferred
• 4+ years of experience in Product Management role
• 2+ years of experience in apps products required
• Proven track record of launching and scaling consumer products. Deep customer empathy to deliver exceptional member experiences.
• Experience with pharmacy benefit management or health insurance preferred
• Experience with agile framework; certified Scrum Product Owner is a plus
• Comfort or experience in a fast-paced, growing environment
• Intellectual and professional curiosity
• Highly analytical; experience using analytical tools to manage customer engagement and identify key insights
• Excellent communication and collaboration skills
• Ability to manage conflicting priorities in a deadline driven environment.
• Strong attention to detail and project management skills

Position Summary:

We are seeking a passionate and driven Product Manager with a strong background in consumer-facing mobile applications to drive the vision, strategy, and roadmap for Judi Health’s member-facing app experiences. This role will focus on building intuitive, high-impact mobile solutions that simplify care navigation, enhance engagement, improve health outcomes, and help lower the overall cost of care.

Position Responsibilities:

• Lead the product strategy, development, and enhancements of Judi Health’s Product offerings
• Develop business requirements and specification documents, working with our operations and client management and sales teams
• Accountable for on-time and accurate delivery of product features.
• Participate in product planning, roadmap development, and long-term strategy planning
• Effectively manage and meet stakeholders’ priorities and expectations.
• Support collecting and acting on feedback from internal stakeholders and external clients to iterate and improve upon existing products and ideate and anticipate new products
• Perform backlog grooming, epic planning, refinement, and other scrum events.
• Perform demos of in-market product to clients and prospects.
• Manage and execute day-to-day project management functions with regards to the specific products currently under development
• Analyze product data to derive insights to assist in the prioritization and post release optimization of the products
• Work with design team to conduct user experience testing and research
• Conduct user testing of prior to release to the customer.
• Support general business needs, as required
• Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance

Required Qualifications:

• Bachelor’s degree, Masters Preferred
• 4+ years of experience in Product Management role
• 2+ years of experience in apps products required
• Proven track record of launching and scaling consumer products. Deep customer empathy to deliver exceptional member experiences.
• Experience with pharmacy benefit management or health insurance preferred
• Experience with agile framework; certified Scrum Product Owner is a plus
• Comfort or experience in a fast-paced, growing environment
• Intellectual and professional curiosity
• Highly analytical; experience using analytical tools to manage customer engagement and identify key insights
• Excellent communication and collaboration skills
• Ability to manage conflicting priorities in a deadline driven environment.
• Strong attention to detail and project management skills

Position Summary

The Manager of Client Experience Resolution & Optimization (CERO) leads the intake, triage, and resolution process for client-impacting issues within Client Services. This role establishes governance for intake workflows, ensures issues are accurately validated and routed, and drives consistency in how Client Services manages and resolves operational challenges. The Manager partners across the organization to streamline processes, reduce manual work, and improve end-to-end client experience, while providing coaching for the CERO Analyst.

Position Responsibilities:

• Build and manage a standardized intake and routing process for Client Services issues.
• Govern issue of triage, prioritization, and cross-functional coordination.
• Serve as the primary point of contact for inquiries related to intake, validation, and routing.
• Develop and maintain SOPs, workflows, and documentation supporting Client Services operations.
• Establish and monitor high‑level performance indicators (e.g., intake volumes, turnaround times, quality measures) in partnership with internal analytics teams.
• Lead continuous improvement initiatives aimed at simplifying workflows and reducing recurring issues.
• Partner with functional teams to identify process gaps and support implementation of improvements.
• Coach, mentor, and support ongoing development of the CERO Analyst.

Required Qualifications:

• Bachelor’s degree is required
• 5+ years of experience in client services, operations, or workflow/process management.
• Demonstrated success in establishing governance structures or managing intake of workflows.
• Strong collaboration, communication, and organizational skills.
• Ability to manage complexity and problem-solve in a fast-paced environment.

Capital Rx is a next generation pharmacy benefits manager, overseeing prescription benefit plans on behalf of employers, unions, and government entities. Determined to transform an outdated model, Capital Rx’s mission is to change the way prescription benefits are priced and administered in the US, unlocking enduring social change. Through our platform approach, Capital Rx delivers data-driven insights and actionable strategies that reduce costs, while improving patient outcomes. Our commitment to innovation, technology, and service is the reason why Capital Rx is among the fastest-growing PBMs in the country.

Position Responsibilities:

• Lead and nurture a dynamic team of clinical pharmacists and technicians dedicated to the prior authorization and appeals process.
• Create and uphold robust policies and procedures for utilization management review.
• Utilize available data to optimize prior authorization staffing and streamline workflow.
• Actively participate in goal setting and regularly evaluate the performance of the PA team.
• Respond to requests for information (RFI) and requests for proposal (RFP) regarding prior authorization processes.
• Generate and deliver comprehensive reports on prior authorization metrics to both internal and external stakeholders.
• Manage contracts with external Independent Review Organizations and clinical resource vendors
• Supervise the UM quality management process to ensure compliance with state, federal, and regulatory guidelines.
• Participates in the quality improvement committee and supports quality improvement projects as required by URAC.
• Oversee clinical criteria and decision tree creation and maintenance.
• Lead the recruitment and onboarding process for pharmacists and technicians.
• Support the training and growth of both new and existing staff members in adherence to proper procedures.
• Investigate and resolve escalated issues from clients and clinical partners as needed.
• Works with Director, Prior Authorization on other responsibilities, projects, and initiatives as needed.
• Perform day to day clinical pharmacy functions including prior authorization and appeal reviews, override requests, and inbound and outbound member and provider education calls.
• Schedule requires working Monday through Friday with occasional on‑call responsibilities and the flexibility to work outside of regular business hours based on business needs.

Required Qualifications:

• Active, unrestricted, pharmacist license required
• Bachelor of Pharmacy or Doctorate of Pharmacy Degree required
• 4+ years of prior authorization experience at a PBM or health plan
• 3+ years of leadership experience preferred
• Experience with multiple lines of business including Commercial and Medicare Part D preferred
• Exhibit strong written communication and oral presentation skills
• Proficient in Microsoft office Suite with an emphasis on PowerPoint and Excel
• Ability to work in a fast-paced environment with shifting priorities
• Attention to detail & commitment to delivering high-quality work

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.

Remote, US Salary Range
$155,000.00 - $170,000.00 USD  
New York, NY Salary Range
$128,000.00 - $160,000.00 USD  
Denver, CO Salary Range
$117,600.00 - $147,000.00 USD  

Position Summary

We are seeking an experienced and strategic Project Manager to lead the delivery of high‑impact, cross‑functional initiatives. This role is responsible for managing multiple complex projects from inception through execution, ensuring alignment with business objectives, compliance standards, and operational best practices. The ideal candidate brings strong communication, stakeholder management, problem‑solving, and risk mitigation skills, with a proven ability to deliver results in a fast‑paced environment.

Position Responsibilities:

• Manage concurrent client audits or team projects, coordinating with internal and external stakeholders to ensure on‑time, on‑scope delivery.
• Develop, maintain, and execute detailed project plans, including scope, timelines, milestones, resource allocation, and task assignments across simultaneous audits and initiatives.
• Drive end‑to‑end project execution from initiation through closeout, ensuring alignment with business objectives and contractual requirements.
• Serve as the primary point of contact in external auditor and consultant meetings, leading kickoffs, clarifying scope and procedures, and managing expectations.
• Monitor project progress and performance, proactively managing risks, issues, dependencies, and scope changes.
• Collaborate closely with cross‑functional subject matter experts (e.g., Account Management, Analytics, Network, Provider Relations, Product, Compliance, etc.) to gather deliverables, review findings, provide responses, complete corrective actions, and ensure follow‑ups are owned and closed.
• Maintain clear, consistent communication through status updates, dashboards, and presentations for stakeholders and leadership.
• Build and maintain strategic relationships with external consultants, auditors and internal teams.
• Ensure quality, compliance, and governance by maintaining complete project documentation, leveraging project management tools (e.g., Jira, Confluence, Asana), and driving continuous process improvement.
• Support general business needs, as required.
• Responsible for the adherence to the Capital Rx Code of Conduct including reporting of noncompliance.

Required Qualifications:

• Bachelor’s degree in a related field
• 3+ years of proven experience in project management
• PMP or equivalent certification is strongly preferred
• Experience in healthcare, pharmacy benefit management, pharmacy claims audit, or health tech environments is highly desirable
• Proficiency with project management tools (e.g., Jira, Confluence, Asana, etc.).
• Track record of leading cross-functional projects, driving high performance, meeting deadlines, and executing on deliverables
• Strong attention to detail with an intellectual and professional curiosity along with a passion for continuous improvement
• Ability to balance multiple complex projects simultaneously
• Exceptional communication and stakeholder management skills
• Extremely flexible, highly organized, and able to shift priorities easily

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

Position Responsibilities:

• Support RFP/RFI opportunities for new and renewal PBM opportunities with low to moderate complexity.
• Comply fully with Capital Rx’s policies and procedures for proposal development.
• Support the creation and maintenance of consultant templates for assigned channel partners.
• Create and refine SOPs to support RFP response development and submission working in collaboration with proposal managers and directors.
• Within 9-12 months following hire date, demonstrate mastery of Capital Rx’s products, services, and financial model to complete assignments with minimal oversight.
• Comply with Capital Rx’s time and attendance policies for all salaried employees, including working a base of 40 hours per week.
• Responsible for adherence to the Capital Rx Code of Conduct, including reporting of noncompliance.
• Support the management of the RFP response database by returning new and revised responses to the RFP Content Manager.
• Assist in the creation and ongoing updates/edits to new RFP content.
• Help obtain and catalog ancillary RFP samples and attachments.
• Assist Content Manager with day-to-day maintenance of RFP library content (Qvidian).
• Assist Content Manager with maintenance of SME list.
• Contribute ideas for improvement across proposal & underwriting department including content management processes or tools.

Minimum Qualifications:

• Undergraduate bachelor’s degree, with record of strong academic performance in English, Journalism, Marketing or Communications
• 1+ years of proven experience in proposal writing, project management, or benefits consulting
• Attention to detail & commitment to delivering high quality work product
• Extremely flexible, highly organized, and able to shift priorities easily
• Ability to lead multiple projects simultaneously and balance a range of key internal and external stakeholders
• Track record of supporting multiple projects simultaneously, driving high performance, meeting deadlines, and executing on deliverables
• Proficient in Microsoft Office, Adobe, and other editing software
• Experience with RFP library software such as Qvidian, Loopio, Responsive, Expedience, etc. preferred
• Knowledge of healthcare industry trends and best practices
• Ability to write in plain language
• Exceptional written and verbal communication skills, including technical copy editing
• Passion for learning, including intricacies of pharmacy benefits products

Nothing in this position description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

Remote, US Salary Range
$75,000.00 - $87,000.00 USD  
New York, NY Salary Range
$74,000.00 - $92,500.00 USD  
Denver, CO Salary Range
$67,600.00 - $84,500.00 USD  

Benefits

Judi Health provides all full-time and part-time benefit-eligible employees with the ability to elect medical and pharmacy coverage, dental insurance, vision insurance, accidental injury insurance, critical illness insurance, hospital indemnity insurance, and flexible spending accounts. Full-time employees also have access to a health savings account, voluntary life insurance, and voluntary accidental death and dismemberment insurance for themselves and their eligible dependents.

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.

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.

Location: Remote (For Non-Local) or Hybrid (Local to New York, NY or Denver, CO area)

Position Summary

The Benefit Configuration Specialist is responsible for supporting the testing and validation of pharmacy benefit plan configurations across multiple lines of business, including Commercial, Medicaid, Exchange, and Medicare. This role ensures that benefit plan setups align with client intent, regulatory requirements, and internal configuration standards.The Specialist will execute comprehensive benefit testing, participate in pre-implementation audits, and validate plan accuracy prior to deployment. Responsibilities include reviewing plan design specifications, performing scenario-based testing, identifying configuration discrepancies, and collaborating with cross-functional teams to resolve issues. This position requires strong attention to detail, analytical thinking, and the ability to interpret complex pharmacy benefit structures. The ideal candidate is comfortable working in a fast-paced environment, managing multiple audits simultaneously, and communicating findings clearly to internal stakeholders.

Position Responsibilities:

• Execute end-to-end testing and validation of pharmacy benefit plan configurations across Commercial, Medicaid, Exchange, and Medicare lines of business.
• Perform detailed implementation audits to ensure benefit setup aligns with client intent, regulatory requirements, and internal configuration standards.
• Review and interpret plan design documents, benefit change forms, and formulary specifications to translate requirements into executable test scenarios.
• Analyze claim outputs to confirm expected adjudication behavior and accumulator movement.
• Identify, document, and communicate configuration discrepancies or defects; collaborate with configuration team to ensure timely resolution.
• Ensure compliance with applicable federal and state regulations, including guidance from the Centers for Medicare & Medicaid Services (CMS) where applicable.
• Maintain clear documentation of testing results, audit findings, and approval signoffs.
• Participate in client-facing meetings to review testing scope, discuss audit findings, clarify benefit intent, and provide detailed explanations of testing results and configuration outcomes.
• Partner with cross-functional teams to ensure benefit accuracy and successful implementation.
• Contribute to process improvements that enhance testing efficiency, audit quality, and overall benefit validation standards.
• Manage multiple audits and testing initiatives simultaneously in a deadline-driven environment.
• Responsible for adherence to the Capital Rx Code of Conduct

Required Qualifications:

• Bachelor’s degree in Healthcare Administration, Business, Information Systems, or related field (or equivalent work experience).
• Minimum 3–5 years of experience in pharmacy benefit management (PBM), health plan operations, or benefit configuration.
• Direct experience supporting Medicare lines of business (Medicare Part D and/or MAPD).
• Demonstrated understanding of Medicare benefit structures.
• Experience testing and validating pharmacy benefit configurations in Commercial, Medicaid, Exchange, and/or Medicare lines of business.
• Strong knowledge of formulary design, tier structures, utilization management (PA, ST, QL), and accumulator logic.
• Ability to analyze benefit design documents and translate requirements into executable test scenarios.
• Strong analytical skills with high attention to detail and accuracy.
• Proficiency in Microsoft Excel for data review, validation, and reporting.
• Strong written and verbal communication skills with ability to clearly document findings and discrepancies.
• Participate in client-facing discussions to review benefit testing outcomes and implementation readiness while providing clear guidance on complex benefit designs.

Base Salary:

• New York, NY (hybrid) $78,800 - $98,500
• Denver, CO (hybrid) $72,000 - $90,000
• Remote -  $62,400.00 - $90,000.00

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, and skills, and location of the job.

Nothing in this position description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

Benefits

Judi Health provides all full-time and part-time benefit-eligible employees with the ability to elect medical and pharmacy coverage, dental insurance, vision insurance, accidental injury insurance, critical illness insurance, hospital indemnity insurance, and flexible spending accounts. Full-time employees also have access to a health savings account, voluntary life insurance, and voluntary accidental death and dismemberment insurance for themselves and their eligible dependents.

Judi Health provides full-time employees with the following benefits at no cost to the employee: basic life insurance, basic accidental death and dismemberment insurance, paid time off, sick time, holidays, short-term disability, long-term disability, an employee assistance program, and a wellness program. Full-time employees are also eligible for a 401(k) plan with company match after one year of full-time employment.

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.

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.

Location: Hybrid (Local to NYC)

Position Summary: 

The Provider Relations Specialist provides essential credentialing review and management to support the Capital Rx networks of pharmacies. This work involves deciding whether pharmacies meeting Capital Rx’s credentialing requirements allowing for inclusion in the Capital Rx pharmacy networks and maintaining the information related to credentialing. The ideal candidate will have experience in credentialing providers, managing reporting requests, and contribute to scalable solutions to streamline processes.  

Position Responsibilities: 

• Manage the standard credentialing review process for applicable pharmacies for inclusion in the provider networks and maintain the information related to credentialing so that Capital Rx has the most relevant information available. This includes getting applicable licenses and certificates of insurance from pharmacies as well as verifying eligibility in the NCPDP database and federal and state websites (e.g. OIG, GSA, SAM) and using that information to decide whether the pharmacy meets the credentialing requirements for Capital Rx.  

• Manage, review and decide whether the applicable pharmacies are valid by reviewing exclusion lists on an ongoing basis to identify any excluded pharmacies and referring those pharmacies to the appropriate team members/departments for removal. 

• Manage the development and maintenance of a credentialing database to ensure proper tracking of all relevant credentialing information. 

• Manage credentialing reporting requests. 

• Gather and track annual pharmacy required attestations. 

• Manage and review development and implement of credentialing policies and procedures. 

• Gather pertinent information from pharmacies regarding services offered and opportunities and provide direct contracting support to Provider Relations leadership as needed. 
• Provide other assistance as assigned to the Provider Relations team. 

Required Qualifications: 

• 2+ yrs. of experience in healthcare, pharmacy credentialing, contracting, provider relations, pharmacy, account management or other relevant experience. 

• Proven track record of working in a fast-paced environment, managing multiple tasks at once and having a go-get attitude to provide persistent outreach to pharmacy providers to close out contracts and tasks. 

• Ability to work independently, track work/projects appropriately and remain on task. 

• Strong communication skills with the ability to develop effective working relationships with providers and internal and external stakeholders. 
• Intermediate level of proficiency with Microsoft Excel, Word, PowerPoint. 

Preferred Qualifications: 

• PBM and pharmacy technician experience preferred 

• Bachelor’s degree preferred 

Position Summary:

The QA Pharmacist will use their state regulatory knowledge to perform routine auditing and monitoring processes to ensure quality, accuracy, and regulatory compliance of coverage requests and appeals. The QA Pharmacist will utilize a strong comprehension of regulatory requirements to ensure success in annual reporting, program audits, and ad hoc audits.

Position Responsibilities:

• Complete monthly utilization management and appeals performance and process audits in alignment with applicable regulations, accreditation standards, and best practices. 
• Create and maintain progress reports and audit results in accordance with regulatory/accreditation requirements and internal processes.
• Present audit results to leadership in a timely manner to address issues and ensure adherence to departmental procedures and regulatory/accreditation requirements (CMS, URAC, NCQA).
• Continuously review and remain informed of all regulatory/accreditation requirements and updates impacting the coverage request and appeals processes.
• Respond to inquiries from internal and external stakeholders regarding quality assurance processes, audit results, and compliance policies and procedures.
• Work independently and with team members as warranted by audit assignment. 
• Assist in designing and implementing audit tools and programs, creating QA scorecards and guides in collaboration with all department stakeholders. 
• Provide ongoing performance feedback, to team leads to ensure consistent performance.
• Assist management in identifying, evaluating, and mitigating operational, and compliance risks.
• Work in collaboration with operational leaders to identify training opportunities and recommend improvements to Work Instructions, Job Aids, and Policy and Procedures to improve performance.

Minimum Qualifications:

• Active, unrestricted, pharmacist license required
• 2+ years of state regulatory and audit utilization management experience at a PBM or health plan required
• Extensive knowledge of how to operationalize regulatory requirements
• Strong oral and written communication skills required
• Intermediate to advanced Microsoft Excel skills required
• Possess strong analytical skills, attention to detail, quantitative, and problem-solving abilities 
• Ability to work independently with minimal supervision, stay productive in a remote, high-volume, metric driven work environment
• Ability to multi-task and collaborate in a team with shifting priorities

Preferred Qualifications:

• Familiarity/experience with URAC and NCQA accreditation requirements
• Utilization management and/or appeals audit experience
• 3+ years of compliance or regulatory experience at a PBM or health plan

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.

#LI-BC1

Position Summary: 

We are seeking a skilled and passionate Scrum Master to support the development teams in applying agile practices effectively, with a focus on the Scrum framework. This role will foster a culture of continuous improvement, collaboration, and transparency, while guiding teams through agile maturity and delivering high-quality outcomes. 

Position Responsibilities: 

Agile Coaching & Facilitation 

• Facilitate Scrum events and coach teams to self-organize and continuously improve. 
• Design and lead retrospectives tailored to team needs. 
• Conduct quarterly team health checks and maturity assessments. 
• Guide teams in applying lean and agile principles to improve delivery. 

Team & Stakeholder Engagement 

• Foster collaboration between Scrum Teams and stakeholders. 
• Mediate conflicts and support team dynamics to ensure a healthy team environment. 
• Support onboarding and agile adoption for new team members and teams. 

Process Improvement & Metrics 

• Identify and remove impediments to team progress. 
• Leverage empirical data to drive continuous improvement. 
• Prepare and present sprint reports including velocity, capacity, and predictability metrics. 
• Build and maintain workflows and automation to enhance team efficiency. 

Product & Planning Support 

• Collaborate with product teams on backlog management, coaching on prioritization best practices.
• Assist in roadmap development and release forecasting using agile metrics.
• Promote best practices in lean, iterative software delivery.
• Build foundational product knowledge to provide targeted coaching and help bridge gaps between teams working on related features.

• Tracks quarterly goals for team(s)

A Successful Contributor has: 

• Practical experience with multiple agile frameworks and their effective application. 
• Strong facilitation and conflict resolution skills. 
• Experience teaching and mentoring on Scrum and agile principles. 
• Understanding of business strategy techniques like Lean Startup, MVP vs MMF / MMP, and Prioritization Matrices.
• Experience with forecasting and release planning using agile metrics. 
• Knowledge of CI/CD and emergent architecture in iterative development. 
• Ability to build simple automations in Jira, and Slack to support Scrum practices. Familiarity with Github Actions is a plus.
• Strong communication skills grounded in commitment, courage, focus, openness, and respect. 

Qualifications: 

• Bachelor’s Degree in business, information technology, or 3 years’ work experience in related field required. 
• 3 years working in Scrum Master role or on a Scrum Team. 
• Certified Scrum Master (CSM) or equivalent certification preferred. 

Position Summary

The Drug Pricing Surveillance Senior Analyst will play a key role in advancing Capital Rx’s pharmaceutical pricing strategy by collecting, analyzing, and interpreting market data across diverse reimbursement and distribution channels. This role partners closely with cross‑functional teams—including Analytics, Legal, Network Management, and Audit—to compare market pricing to Judi Health’s contracted rates, surface pricing variability, and identify opportunities for improved value for client plans and their members. The specialist will design integrated, user‑friendly reporting that enables data‑driven decision‑making and supports operational workflows across the organization. Additionally, this role contributes to safeguarding fiduciary responsibilities by helping stakeholders understand evolving industry dynamics and compliance expectations. The ideal candidate brings strong analytical skills, experience with pharmaceutical or healthcare data, exceptional communication abilities, and the capacity to manage multiple complex projects in a fast‑paced environment.

Position Responsibilities:

• Pharmaceutical Market Data Collection: Collect data on available prices to end users for pharmaceuticals across distribution and reimbursement channels, including traditional insurance reimbursement, direct-to-patient, and direct-to-employer models
• Pricing Comparison and Analytics: Use available reporting and analytics tools (and collaborate with our dedicated Analytics team) to compare available market pricing to Judi Health’s contracted pricing for pharmaceuticals; facilitate executive understanding of pricing variability
• Opportunity Analyses: Identify and investigate opportunities for pricing improvement, working with other teams and departments to scope initiatives aimed at achieving more favorable pricing for client plans and their members
• Integrated Report Design: Design and implement pricing variability data reporting for consumption by users across teams and levels that can be integrated into workflows of relevant teams (for example, audit, network management, etc.)
• Fiduciary Duty Protection: Use industry news and direction from our Legal team to facilitate understanding among key stakeholders of health plan sponsor fiduciary duty and our strategies to fulfill our responsibilities as dedicated administrators

Required Qualifications:

• Bachelor’s Degree required
• 2+ years of experience with significant data analytics responsibilities applicable to pharmaceutical pricing, such as in a health plan, PBM, value-based care, or managed care environment; consulting, advising, or tech enablement focused on the preceding areas also considered applicable
• Ability to balance multiple complex projects simultaneously with minimal direction
• Great time-management and organizational skills to manage multiple active projects simultaneously
• Exceptional written, verbal, and presentation skills
• Experience working with data reporting tools, conducting data analyses, and effectively consuming/interpreting data reports and visualizations
• Proficient in Microsoft Office Suite with emphasis on Microsoft Excel and PowerPoint
• Experience with programming languages relevant to data analytics, such as SQL or Python

Preferred Qualifications:

• Master’s Degree in relevant field (Management, Accounting, Healthcare Administration, Health Policy, Data Science, etc.)
• Experience with prescription drug channels and payment workflows (pharmacy reimbursement, rebate administration and GPO relations, regulatory requirements, etc.)
• Experience with health insurance or health benefits administration (pharmacy benefits in particular)
• Experience producing reporting that facilitates data-driven decisions and workflows for stakeholders across functions and levels
• Ability to think strategically and identify inefficiencies, develop long-term solutions, and challenge and improve existing processes through automation and redesign
• Highly detail-oriented and analytical
• Ability to travel occasionally as needed for internal, client, and vendor/partner meetings

Position Summary: 

The Senior Analyst, Government Programs Operations - Analysis & Efficiencies will play a pivotal role in supporting the operational success of Medicare, Medicaid, and the Exchange programs. This analyst develops data-driven solutions that enhance efficiency and reduce manual efforts. Under the guidance of the Operations Manager, this analyst utilizes complex datasets to identify actionable insights that inform strategic decisions and drive ongoing improvement. The analyst’s responsibilities encompass delivering recurring and ad-hoc reports, designing and leading the implementation of BI dashboards, and creating standardized code templates to automate deliverables. Additionally, the analyst contributes to process optimization by designing scalable, automated solutions that streamline workflows and minimize manual intervention. Collaboration with cross-functional teams, including compliance, product, sales, marketing, underwriting, implementation, client services, and clinical operations, is crucial to ensure that analytical tools and operational capabilities align with both regulatory requirements and business objectives.

Position Responsibilities: 

• Analyze complex datasets to identify trends, outliers, and opportunities for operational improvement across Medicare, Medicaid, and Exchange programs

• Develop and maintain recurring and ad-hoc reports, dashboards, and analytical tools to support data-driven decision-making

• Create and maintain a repository of standardized code templates to streamline report generation and automate routine tasks

• Ensure analytical outputs align with regulatory requirements and business objectives by interpreting CMS and state guidance in partnership with internal subject matter experts.

• Support the development of scalable processes that enhance efficiency, accuracy, and responsiveness across government program operations

• Design and implement automated solutions to reduce manual effort and improve process scalability and accuracy

• Implements and uses analytical software to support the department in achieving goals as defined by executive leadership

• Facilitate requirements gathering sessions to understand business needs and translate them into actionable analytical deliverables

• Analyzes business workflow and system needs for conversions and migrations to ensure that encounter, recovery, and cost savings regulations are met

• Presents and communicates complex analytical findings in a clear and concise manner

• Participates in user acceptance, and quality assurance testing of new application features and team deliverables

• Supports root-cause-analysis and reporting of encounter data issues/errors by partnering with key stakeholders – Will also provide operationally support

• Prepares high-level user documentation and training materials as needed

• Work with internal and external clients to research, develop, and document new standards to enhance reporting capabilities

• Collaborate with cross-functional teams—including compliance, product, sales, marketing, underwriting, implementation, client services, and clinical operations—to refine and enhance operational capabilities

• Responsible for adherence to the Capital Rx Code of Conduct, including reporting of noncompliance.

Required Qualifications:

• 4+ years of healthcare data experience

• 4+ years of experience working with SQL, R, or Python

• 4+ years of experience working with business intelligence tools

• Experience performing analyses on large sets of data

• Knowledge of data management, statistics, modeling concepts

• Experience working with cross-functional teams

• Experience with Power BI or other data visualization tools

• Ability to balance multiple complex projects simultaneously

• Extremely flexible, highly organized, and able to shift priorities easily

• Attention to detail & commitment to delivering high-quality work product

• Bachelor's degree in Business Administration, Data Analytics or 4+ years of relevant experience

Preferred Qualifications:

• 4+ years of proven experience in government programs

• 3+ years of experience working with pharmacy data

• Experience with Medicare(Part D), Medicaid, and/or Marketplace Pharmacy Data/Processes

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

Position Summary

Join our mission to transform pharmacy benefits. In this development role, you will lead large, high-impact projects, working closely with product managers, designers, and clients to gather both business and technical requirements with a product mindset. You will be at the forefront of technical solutioning, driving enterprise API integrations, data migrations, data exchange, and prioritizing security. This role involves extensive client interactions, API development, and ensuring scalability. You will collaborate cross-functionally across internal teams and various departments within our client organizations to accelerate program technical deliveries. This is an exciting opportunity to redefine the pharmacy benefits landscape through collaboration and cutting-edge cloud technology.

Why You’ll Love Working Here 

• Opportunity to lead high-impact, client-facing initiatives that directly influence key business metrics.
• Hands-on exposure to architecture, system design, and solving complex scalability challenges in real-world environments.
• Be a catalyst in accelerating client migration and new client onboarding with direct visibility into outcomes.
• Work on a team that values quick, elegant solutions to complex problems where your contributions shape the future of pharmacy benefits.
• We have a remote-first culture.

Position Responsibilities

• Lead the development and deployment of cutting-edge solutions from design to production.
• Collaborate with product managers and cross-functional teams to refine and implement requirements, ensuring seamless integration and user experience.
• Engage with major clients and cross-functional teams to architect innovative solutions and enhance product functionality.
• Establish and maintain consistent, enterprise-grade APIs across services, ensuring interoperability and scalability while employing best practices for interactions with both partner and internal systems.
• Build robust backend applications in Python on AWS Lambda, API Gateway, SMS, ECS, and other cloud technologies.
• Implement backend code in a serverless, cloud-native environment (Flask/AWS Lambda/ECS).
• Design and implement scalable systems capable of handling high-volume transactions, ensuring robustness and reliability.
• Ensure security best practices are followed in all aspects of development and deployment.
• Conduct code reviews to maintain high code quality and standards.
• Demonstrate technical leadership, driving timely execution and high-quality software delivery.
• Make informed architectural decisions through careful evaluation and leveraging prior experience.
• Self-manage tasks, collaborate effectively with both internal and external teams, and drive projects to successful completion.
• Represent the software development team’s products to stakeholders, providing technical insights and solutions.

Qualifications

• 7+ years of related job experience with a broad range of technical skills.
• Desire to work in a health technology company; previous Pharmacy Benefits Manager (PBM) experience is a plus.
• Strong experience in Python (Flask/SQLAlchemy) and TypeScript (React).
• Advanced PostgreSQL database knowledge, including common table expressions, windowing functions, views, stored procedures, and indexing techniques (full-text or geospatial).
• Experience working with microservices, an API-based application paradigm, and distributed caching techniques.
• Proven ability to deliver complex web applications to the cloud, targeting infrastructure as code with a security mindset (AWS, Terraform).
• Demonstrated ability to improve scalability and observability of systems.
• Proficiency in Linux using Bash, Zsh, Python, Node.js and similar tools.
• Experience with Git code management, preferably in a mono repository.
• Strong knowledge of unit testing across multiple paradigms and integration testing using frameworks like Playwright.
• Excellent verbal and written communication skills, enabling effective collaboration in a remote environment and with major clients' technical and non-technical teams
• Strong problem-solving skills and a proactive approach to identifying and addressing potential issues.
• Prior experience working as a technical lead collecting functional and non-functional requirements, or strong technical product management experience is a plus.

Nothing in this position description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

Location: Hybrid (Local to NYC or Denver areas) or Remote-US

Position Summary:

The Business Analyst provides support gathering and documenting business and reporting requirements that align with state and federal guidelines. This individual will analyze complex problems and issues using available information from both internal and external sources. Other responsibilities will include – creating specifications documents for business processes, reports, data extracts, and analyses based on business needs. Identify and interpret trends in datasets to find possible outliers or patterns that can be used to drive process improvements. Collaborates with internal and external cross-functional teams (compliance, product, sales, marketing, underwriting, implementation, client services, clinical operations) to design, refine, automate, and maintain operational capabilities.

Position Responsibilities:

• Monitors for changes in existing business processes and updates documentation accordingly - Finds new opportunities for process developments and improvements
• Intake, analyze and manage requests from stakeholders
• Proactively reviews business processes and data to develop subject matter expertise of processes supported by our team
• Drives root-cause-analysis and resolution of data and processes issues/errors by partnering with key stakeholders
• Supports analytical, problem-solving functions by defining and documenting specifications pertinent to all departmental processes
• Analyzes business workflow and system needs for conversions and migrations to ensure that government submissions, recovery, and cost savings regulations are met
• Prepares end user documentation and training materials as needed
• Support government data submission processes by analyzing complex data issues using data from internal and external sources
• Improve government data submission processes by reviewing and synthesizing state and federal recourses, consolidating into comprehensive business requirements documents
• Support creation of intake request to enhance existing processes by gathering requirements and level setting with stakeholders on required processes
• Develop and set up performance metrics for stakeholder distribution
• Performs root cause analysis of government data processing and submission issues; develops recommendations based on data and industry knowledge

Minimum Qualifications:

• 3+ years of healthcare experience
• 3+ years of business process analysis, preferably in healthcare
• 3+ years of experience with Government Exchange programs
• Demonstratable knowledge of SQL, Excel, and flow-charting tools
• Experience with implementation/project management
• Experience working with cross-functional teams
• Extremely flexible, highly organized, excellent communication and able to shift priorities easily
• Attention to detail & commitment to delivering high-quality work product
• Comfort or experience in a fast-paced, growing environment
• Intellectual and professional curiosity
• Familiarity with the agile framework/Certified Scrum Product Owner preferred
• Bachelor’s degree in Business Administration, Data Analytics, Computer Science or 3+ years of relevant experience

Position Summary:

Join our mission to transform pharmacy benefits and healthcare navigation as a Senior Data Engineer (Analytics Engineer). You will build and maintain reliable data models within Snowflake with dbt, and improve data quality and observability. Partner with analysts, data scientists, and software engineers to deliver trusted, well-documented datasets that power analytics and products.

Position Responsibilities:

· Build, test, and document Snowflake data models and business logic in dbt

· Apply and improve data quality, testing, observability, and lineage standards

· Collaborate with cross-functional partners to define data contracts and interfaces

· Contribute to Capital Rx’s modular data platform and client-specific data configurations

· Participate in design reviews; propose scalable, maintainable patterns

· Monitor pipeline health, troubleshoot incidents, and drive root-cause fixes

· Optimize cost and performance of jobs, storage, and queries with guidance

· Write clear documentation and support knowledge sharing

· Adhere to the Capital Rx Code of Conduct, including reporting of noncompliance

Preferred Qualifications:

· 5+ years in data engineering, software engineering, or related field

· Strong SQL and Python; solid understanding of ETL/ELT and dimensional/data vault modeling

· Hands-on dbt experience (models, tests, documentation, deployments)

· Experience with orchestration (Dagster or Airflow) and scheduling best practices

· Familiarity with Spark/Databricks and cloud data warehouses (Snowflake preferred)

· CI/CD for data (Git-based workflows, environments), and basic IaC familiarity

· Data observability and testing (dbt tests, Great Expectations/Soda, lineage tools)

· Understanding of security, governance, and privacy for PII/PHI (HIPAA awareness)

· Effective communication and collaboration with technical and non-technical stakeholders

· Bonus if you have Exposure to healthcare data (claims, eligibility, provider directories)

· Performance tuning in Snowflake (warehouse sizing, clustering, caching)

Nothing in this position description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

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.

Position Summary: 

Join our mission to infuse cutting-edge AI/ML/GenAI into pharmacy benefits as a Senior Machine Learning Engineer.  We are looking for an experienced software engineer with machine learning expertise to join us in expanding our AI capabilities, enabling increased productivity and magical experiences in our products and services. 

In this role you will be expected to design and implement complex AI systems that leverage ML models for NLP, NLG, multimodal data analysis, chatbots, and RAG-based QnA. The ideal candidate should be passionate about applying AI/ML concepts to difficult problems and develop scalable solutions. We want people who like working in a collaborative team environment and enjoy creating practical, efficient, and high-performance software that leverages Large Language Models (LLM), Multimodal Language Models(MLM), and other ML models and techniques to build amazing capabilities for our customers, partners, and employees. Most importantly, we are a mission-oriented, high-growth startup and we are looking for folks that are excited to be part of our journey to make lasting impact towards transforming healthcare. 

Responsibilities: 

• Design, develop, and productionize machine learning (ML) solutions in the fields of Document understanding, Search and QnA, GenAI, Virtual Agents, etc. 
• Develop and maintain backend services using Python, focusing on AI-driven applications. 
• Design and implement APIs for seamless integration with AI models and services. 
• Work across the complete lifecycle of ML model development, including problem definition, data exploration, feature engineering, model training, validation, and deployment. 
• Participate in code reviews, testing, and quality assurance processes. 
• Troubleshoot and resolve technical issues related to AI model, integration, deployment and backend services. 
• Implement system telemetry, A/B testing and other statistical methods to validate the effectiveness of AI models. Ensure the integrity and robustness of ML solutions by developing automated testing and validation processes. 
• Document and communicate development processes, system designs, and architectural decisions. 
• Ensure the security and compliance of healthcare data, adhering to HIPAA regulations. 
• Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance.

Required Qualifications: 

• Bachelor’s or Master’s degree in Computer Science, Machine Learning, or a related quantitative field. 
• Minimum 2 years of experience in industry with a strong focus on ML solutions development and production deployment. 
• Strong grasp of OOP, Design Patterns, efficient algorithms, and quality software development. 
• Strong proficiency in Python in modern Python frameworks such as FastAPI and LangGraph. 
• Experience working with voice AI technologies and conversational AI. 
•  Deepgram, PlayHT, ElevenLabs 
• Telephony technologies, such as Twilio is a big plus 
• Familiarity with cloud platforms such as AWS or Azure. 
• Excellent problem-solving skills, attention to detail, and a strong capacity for logical thinking. 
• Passion for customer, innovation, product quality, service excellence, and test engineering 
• The ability to work collaboratively across multiple disciplines in an extremely fast-paced, startup environment. 
• Experience working with microservices/an API-based application paradigm. 
• Good written communication skills that enable collaboration in a remote environment. 

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.

Position Summary:

Join our mission to infuse cutting-edge AI/ML/GenAI into pharmacy benefits as a Senior Machine Learning Engineer. We are looking for an experienced software engineer with machine learning expertise to join us in expanding our AI capabilities, enabling increased productivity and magical experiences in our products and services.

In this role you will be expected to design and implement complex AI systems that leverage ML models for NLP, NLG, multimodal data analysis, chatbots, and RAG-based QnA. The ideal candidate should be passionate about applying AI/ML concepts to difficult problems and develop scalable solutions. We want people who like working in a collaborative team environment and enjoy creating practical, efficient, and high-performance software that leverages Large Language Models (LLM), Multimodal Language Models(MLM), and other ML models and techniques to build amazing capabilities for our customers, partners, and employees. Most importantly, we are a mission-oriented, high-growth startup and we are looking for folks that are excited to be part of our journey to make lasting impact towards transforming healthcare.

Responsibilities:

• Design, develop, and productionize machine learning (ML) solutions in the fields of Document understanding, Search and QnA, GenAI, Virtual Agents, etc.

• Develop and maintain backend services using Python, focusing on AI-driven applications.

• Design and implement APIs for seamless integration with AI models and services.

• Collaborate with product managers, engineers, and other stakeholders as a specialist and subject matter expert in machine learning.

• Work across the complete lifecycle of ML model development, including problem definition, data exploration, feature engineering, model training, validation, and deployment.

• Participate in code reviews, testing, and quality assurance processes.

• Troubleshoot and resolve technical issues related to AI model, integration, deployment and backend services.

• Implement system telemetry, A/B testing and other statistical methods to validate the effectiveness of AI models. Ensure the integrity and robustness of ML solutions by developing automated testing and validation processes.

• Document and communicate development processes, system designs, and architectural decisions.

• Ensure the security and compliance of healthcare data, adhering to HIPAA regulations.

• Responsible for adherence to the Capital Rx Code of Conduct, including reporting of noncompliance. 

Required Qualifications:

• Bachelor’s or Master’s degree in Computer Science, Machine Learning, or a related quantitative field.

• Minimum 6+ years of experience in industry with a strong focus on ML solutions development and production deployment.

• Strong grasp of OOP, Design Patterns, efficient algorithms, and quality software development.

• Strong proficiency in Python and familiarity with ML libraries such as PyTorch.

• Statistical Machine Learning and Artificial Intelligence in the context of NLP, Speech, RAG, Virtual Agents, and/or Document Processing technologies

• Familiarity with cloud platforms such as AWS or Azure.

• Familiarity with GenAI services such as OpenAI GPT, Anthropic Claude, Google Gemma etc. Experience developing and fine-tuning prompts on any of the GenAI services

• Excellent problem-solving skills, attention to detail, and a strong capacity for logical thinking.

• Passion for customer, innovation, product quality, service excellence, and test engineering

• The ability to work collaboratively across multiple disciplines in an extremely fast-paced, startup environment.

• Experience working with microservices/an API-based application paradigm.

• Good written communication skills that enable collaboration in a remote environment.

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.

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

Position Summary:

The Senior Manager is responsible for leading the end‑to‑end implementation, governance, and change management of regulatory requirements for Exchange plans and EDGE Server operations. This role oversees the delivery of CMS submissions, compliance activities, contract applications, and bid‑related client support, while also coordinating responses to federal and state regulatory audits. The Senior Manager ensures all regulatory reporting obligations are met for Exchange clients by interpreting CMS and state guidance, partnering with internal subject matter experts and client teams, and translating requirements into operational processes. Using structured research, analysis, testing, and validation, this role ensures that systems, workflows, and data submissions consistently meet regulator expectations and client objectives.

Position Responsibilities:

• Lead Government Programs support for Exchange business functions including claims adjudication, regulatory reporting, and audit support (Government, and Client).
• Leads the interpretation, implementation and monitoring of all relevant regulatory requirements and changes impacting Capital Rx’s Exchange Programs.
• Establish and maintain the EDGE pharmacy submission playbook (file intent, lineage, duplicate controls, timestamp standards, enrollment alignment).
• Define and enforce submission cadences, pre‑submission QA gates, and accept/active/non‑orphan targets that meet CMS sufficiency timelines.
• Translate CMS updates into operational SOPs and training.
• Partners with cross‑functional SMEs to analyze regulatory changes, determine their implications for organizational processes, systems, and client commitments, and leads the coordinated, on‑time implementation of required updates across the enterprise.
• Manages timely response to Government Programs support for RFP/RFI, internal sales, and Exchange client requests.
• Provides key insights on Exchange functions using data analysis, industry knowledge and subject matter expertise to identify opportunities, and develop solutions, for optimization of internal business processes and systems.
• Supports the documentation management of internal policies and procedures, reporting and project specifications, job aids, and workflows for designated Government Programs Operations.
• Leverages profound knowledge of Exchange guidance and understanding of industry and market requirements to support product strategy and service delivery.
• Maintains current knowledge of Exchange requirements to facilitate compliance of ongoing business operations.
• Fosters a high-performance culture through mentoring and collaboration, providing team members with ongoing performance feedback and identifying required changes to existing roles and responsibilities to ensure effectiveness and efficiency.
• Assesses impact of new business to understand scalability and staffing needs.

Required Qualifications:

• 6+ years of relevant Prescription Benefit Management and/or Health Plan experience supporting Exchange plans
• 5+ years people management experience
• Vast knowledge of Exchange regulatory requirements and associated product and/or operational workflows
• Proven success managing multiple complex projects simultaneously
• Extremely flexible, highly organized, and able to shift priorities easily
• Attention to detail & commitment to delivering high quality work product
• Excellent written and verbal communication skills
• Proven success managing cross functional teams and maintaining effective relationships at all levels both internal and external; including government entities

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.

Nothing in this position description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

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.

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.

Position Summary: 

The Provider Relations Specialist provides essential credentialing review and management to support the Capital Rx networks of pharmacies. This work involves deciding whether pharmacies meeting Capital Rx’s credentialing requirements allowing for inclusion in the Capital Rx pharmacy networks and maintaining the information related to credentialing. The ideal candidate will have experience in credentialing providers, managing reporting requests, and contribute to scalable solutions to streamline processes.  

Position Responsibilities: 

• Manage the standard credentialing review process for applicable pharmacies for inclusion in the provider networks and maintain the information related to credentialing so that Capital Rx has the most relevant information available. This includes getting applicable licenses and certificates of insurance from pharmacies as well as verifying eligibility in the NCPDP database and federal and state websites (e.g. OIG, GSA, SAM) and using that information to decide whether the pharmacy meets the credentialing requirements for Capital Rx.  

• Manage, review and decide whether the applicable pharmacies are valid by reviewing exclusion lists on an ongoing basis to identify any excluded pharmacies and referring those pharmacies to the appropriate team members/departments for removal. 

• Manage the development and maintenance of a credentialing database to ensure proper tracking of all relevant credentialing information. 

• Manage credentialing reporting requests. 

• Gather and track annual pharmacy required attestations. 

• Manage and review development and implement of credentialing policies and procedures. 

• Gather pertinent information from pharmacies regarding services offered and opportunities and provide direct contracting support to Provider Relations leadership as needed. 
• Provide other assistance as assigned to the Provider Relations team. 

Required Qualifications: 

• 2+ yrs. of experience in healthcare, pharmacy credentialing, contracting, provider relations, pharmacy, account management or other relevant experience. 

• Proven track record of working in a fast-paced environment, managing multiple tasks at once and having a go-get attitude to provide persistent outreach to pharmacy providers to close out contracts and tasks. 

• Ability to work independently, track work/projects appropriately and remain on task. 

• Strong communication skills with the ability to develop effective working relationships with providers and internal and external stakeholders. 
• Intermediate level of proficiency with Microsoft Excel, Word, PowerPoint. 

Preferred Qualifications: 

• PBM and pharmacy technician experience preferred 

• Bachelor’s degree preferred 

Position Summary:

Join our first-of-its-kind Integrated Benefits team as a Benefit Operations Specialist, where you will play a pivotal role in delivering comprehensive medical and pharmacy benefit programs for Judi Health clients. You will lead benefit configuration, claims testing, and quality assurance processes, ensuring accuracy and efficiency across all implementations. This position offers the opportunity to influence operational best practices and contribute to a team that is redefining how integrated benefits are delivered in the healthcare space.

Position Responsibilities:

• Responsible for all aspects of benefit configuration, including new plan setup, plan change setup, claims testing, and regular audits
• Drives cross-functional collaboration with the product/dev team as well as additional stakeholder teams to ensure client customized requests are configurable for both new plan setups and plan changes
• Clearly communicate benefit configuration setup and testing process or specific test claims to clients in a concise way that can be understood by users who are not experts in benefit areas
• Make recommendations to streamline the work processes and systems that impact plan/benefit design to create efficiency and quality outcomes
• Works cross-functionally to create new benefit options aligning with market needs, including expansion in government programs
• Develop standards and custom batch testing scenarios and inputs, reviewing test claims output to validate claim accuracy against the clients’ benefit design
• Develops standard policy and procedures, training materials and provide education for training and presentation to cross-functional teams
• Maintain acceptable and appropriate quality levels and production SLA response time
• Participate in client meetings to assess new client benefit information or change requests to ensure design of Judi logic ties to the benefit configuration intended to meet client needs
• Partner with leadership to develop benefit plan designs and ensure that the plan designs meet client requests, Health Plan strategic/business parameters, and all regulatory and other oversight agencies’ requirements
• Partner with Client Services team as clients go live and troubleshoot benefit-related discrepancies, errors, and problems
• Support general business or team needs, as assigned
• Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance

Qualifications:

• Bachelor’s degree preferred
• 5+ years of TPA / health plan experience in Medical Benefit configuration, benefit testing, claims monitoring, SPD creation, Medical Coding or other applicable department needs
• 3+ years of experience with Cigna a plus
• Pharmacy, Dental, or Vision experience a plus
• Self-funded plans, Medicare/Government programs and ERISA experience preferred
• Tremendous attention to detail, ability to shift priorities easily and ability to work in high paced, deadline drive environment.
• Exceptional written and verbal communication skills
• Experience working with product/dev teams and familiarity with Agile, preferred
• Preferred: experience working with structured or unstructured data in Excel, SQL, and other data visualization tools

Certifications:

• IFEBP certification a plus

Position Summary:

This role supports pricing and underwriting and ensuring timely and accurate RFP responses. The position involves collaborating with various teams to refine financial models and reporting, presenting final underwriting to leadership, and driving continuous improvement in pricing and underwriting practices.

Position Responsibilities:

• Direct and execute day-to-day pricing and underwriting for new and renewing business opportunities
• Coordinate with Sales, RFP response, and other business functions to submit timely and complete RFP responses
• Collaborate with Executive Team and other business functions to design, refine, and maintain internal underwriting, financial modeling, and financial reporting SOPs
• Support client contracting, including validation that contract terms align with proposal underwriting parameters
• Present final underwriting to Sales and Executive Team and be able to articulate any potential risk
• Support continued development and maintenance of underwriting and financial reporting system infrastructure
• Mine external data to determine best underwriting practices for each business opportunity
• Manage multiple projects and deadlines as needed
• Work collaboratively across the organization to communicate and support ongoing financial analytics and reporting needs
• Support analysis and development of pricing models for new products
• Support general business needs, as required
• Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance

Required Qualifications

• Bachelor’s degree, with record of strong academic performance in Accounting, Finance, Actuarial Science, Statistics, or Economics (In lieu of a degree, equivalent relevant work experience may be considered)
• 2+ years of proven experience in financial analysis, actuarial services, accounting, pricing & underwriting
• Pharmacy, PBM, or Health Plan experience required
• Knowledge of risk management, statistics, financial modeling
• Experience manipulating large data sets, including the ability to analyze and interpret historical claims data
• Proficient in Excel and data visualization tools
• Experience in either SQL, SAS, or R preferred
• Track record of leading cross-functional initiatives, driving high performance, meeting deadlines, and executing on deliverables
• Ability to balance multiple complex projects simultaneously
• Exceptional technical, analytical, and problem-solving skills
• 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

Position Summary:

Capital Rx is seeking a strategic, client-focused Clinical Account Consultant to support all aspects of clinical functions to service client clinical needs. In this role, you'll ensure client satisfaction, retention, and trend management, while providing clinical support to clients across all lines of business. You’ll collaborate directly with clients to develop and implement formulary and clinical strategies, support contract renewals, and contribute to clinical process improvements. If you’re passionate about delivering exceptional service with a focus on clinical excellence and driving healthcare innovation, we’d love to hear from you!

Position Responsibilities:

• Support clinical aspects of implementation for new clients, plans, plan changes, and other clinical plan set-up requirements. This may include gathering client clinical intent and plan requirements, building/coding plans and formularies, conducting peer-review quality control, and reviewing testing and claims output.
• Actively address all clients’ clinical needs including the management and implementation of custom formularies, clinical criteria, and clinical strategies.
• Comprehend and effectively explain formulary, benefit, and clinical programs to clients, including intervention components, member and plan experience, book of business experience, and regulatory requirements as it directly pertains to clinical functions.
• Meet with clients to discuss clinical trends, review relevant pharmacy data, and provide recommendations with supportive rationale for formulary, clinical and plan management strategies.
• Analyze and interpret pharmacy claims data to identify clinical and plan trends and to offer insights for individual clients and across multiple clients. 
• Communicate drug information to clients and respond to plan-specific clinical inquiries; support resolution of member-specific inquiries.
• Collaborate with cross-functional teams to support sales initiatives, requests for information (RFI), requests for proposal (RFP), and prospect presentations.
• Actively attend and contribute to sales meetings and client presentations with a focus on clinical operations and clinical account management.
• Lead key internal clinical operations initiatives and general business needs/operations, as required.
• Identify and contribute to clinical process improvement efforts.
• Certain times of year may require meeting participation, testing, claims review, or other requirements outside of standard business hours, including weekends.
• Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance.

Required Qualifications:

• Doctor of Pharmacy (PharmD) degree from an accredited institution
• Current, unrestricted registered pharmacist license(s)
• Relevant experience of 3-5 years in a health plan or pharmacy benefits management (PBM)
• Direct account management experience supporting clients across multiple lines of business
• Proficient in Microsoft Office Suite with emphasis on Microsoft Excel
• Experience working with large datasets and analyzing raw data in Excel
• Ability to balance multiple complex projects simultaneously
• Exceptional written and verbal communication skills
• Flexible, highly organized, and able to shift priorities easily
• Attention to detail & commitment to delivering high quality work product
• Ability to travel and present to small and large groups

Preferred Qualifications:

• Completion of managed care residency, preferred
• Prior account management experience of at least three (3) years, preferred
• Prior experience with Medicare line of business, preferred

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.

Remote, US Salary Range
$145,000.00 - $165,000.00 USD  
New York, NY Salary Range
$139,600.00 - $174,500.00 USD  
Denver, CO Salary Range
$128,000.00 - $160,000.00 USD  

Position Summary:

This individual will report to the Associate Director of Clinical Programs Business Development and be responsible for supporting the sales and profitability of Capital Rx’s suite of clinical programs. This role serves as a primary business development lead for clinical offerings, from opportunity identification, client presentations, to negotiations and contracting.  This role will drive clinical programs sales to new and existing PBM clients and foster strategic relationships with consultant groups. The ideal candidate will combine clinical expertise with strategic sales acumen to expand program adoption and deliver measurable value to clients. This is a base salary plus commission role. 

Position Responsibilities:

• Drive the sales strategy for Capital Rx’s suite of clinical programs end-to-end from prospecting through close.
• Proactively assess client data to identify opportunities, meet with account teams to qualify opportunities, and deliver compelling presentations, proposals, and ROI analyses to prospects to drive clinical program sales.
• Develop and implement strategic plans to identify, engage, and close new clinical program opportunities.
• Cultivate and manage trusted relationships with pharmacy benefit consultant groups, serving as a subject matter expert for our clinical programs.
• Maintain a strong understanding of market dynamics, competitive landscape, and client needs to inform sales strategy.
• Contribute to strategic client retention initiatives by aligning clinical programs with client goals.
• Demonstrate strong analytical, presentation, and CRM skills to support sales execution and tracking.
• Maintain a deep understanding of clinical programs, regulatory requirements (e.g., CMS, NCQA, URAC), and industry trends to effectively position our solutions.
• Serve as a liaison between the field and internal product/clinical teams to ensure offerings remain competitive and relevant.
• Support implementation handoffs to ensure smooth onboarding of new clients.
• Provide market feedback to inform future product development and innovation.
• Support general business needs and operations, as required.
• All employees are responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance.

Minimum Qualifications:

• MBA degree and/or certification in sales or business
• 3+ years of applicable experience in a health plan or PBM, or healthcare sales and/or completion of a PGY1 Clinical Pharmacy Residency Program, Managed Care Residency or Fellowship with additional 2+ years of applicable experience
• Exceptional negotiation, presentation, and communication skills with the ability to articulate clinical value propositions to diverse audiences.
• Experience engaging or partnering with pharmacy consultant firms
• Working knowledge of pharmacy benefit management, Medicare Part D, and commercial pharmacy benefits
• Ability to analyze data and market trends to inform sales strategy and client recommendations.
• Proven track record of meeting or exceeding sales targets and successfully closing complex B2B deals.
• Maintain an active, unrestricted pharmacy license in the state of residence
• Ability to balance multiple complex projects simultaneously with minimal direction
• Ability to travel up to 50%

Preferred Qualifications:

• PharmD
• Experience working with HEDIS, Stars and PQA pharmacy quality measures
• Proficient in Microsoft Office Suite with emphasis on Microsoft Excel and PowerPoint
• Experience with Confluence, Jira, Tableau
• Highly detail-oriented and analytical

Visa Sponsorship: Capital Rx does not provide sponsorship to any candidates. This includes, but is not limited to those that require H1-B, TN, OPT, etc. Candidates must have authorization to work in the US at the time of application and throughout employment.

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.

Position Summary:

As an individual contributor on the Product team, you will pay a critical role in contributing to the success of Capital Rx. The Capital Rx Product team seeks individuals who are passionate about improving the landscape of pharmacy prior authorizations, while providing superior service. The expectations for growth in this role are to push beyond the core data and reporting and to serve as an expert across all domains of Judi, our Enterprise Health Platform.

Position Responsibilities:

• Provide subject matter expertise support on Judi’s function and reporting capabilities related to prior authorization
• Take accountability for accurate translation of reporting requirements for Capital Rx’s customers 
• Support analytics and reporting needs for the prior authorization team and related groups
• Own swift resolution and clear communication of critical reporting issues
• Present analysis results clearly
• Assist in testing of new Judi functionality to ensure enhancements are functioning as expected and accurately processing claims transactions
• Build key cross-functional relationships with other internal teams
• Provide virtual and in person product demonstrations
• Note: Role may periodically require meeting participation, service support or other requirements outside of standard business hours

Minimum Qualifications:

• Bachelor’s degree, with record of strong academic performance in Computer Science, Actuarial Science, Statistics, or Economics or equivalent work experience strongly preferred
• 2+ years of proven experience in data analytics and reporting required
• 2+ years of experience in Structured Query Language (SQL) required
• 2+ years of experience with ETL or ELT preferred
• 2+ years of PBM, pharmacy, health plan, or related experience preferred
• 1+ years working with JSON or other data-exchange format tools preferred
• 1+ year of Python, R, or similar programming experience preferred
• Experience presenting analysis to clients and/or management preferred
• Proficient in Microsoft Excel
• Extremely organized, detail-oriented, and able to easily pivot priorities
• Ability to work effectively with virtual teams
• Ability to travel 5-10%

Position Summary:

As an individual contributor on the Product team, you will pay a critical role in contributing to the success of Capital Rx. The Capital Rx Product team seeks individuals who are passionate about improving the landscape of pharmacy prior authorizations, while providing superior service. The expectations for growth in this role are to push beyond the core data and reporting and to serve as an expert across all domains of Judi, our Enterprise Health Platform.

Position Responsibilities:

• Provide subject matter expertise support on Judi’s function and reporting capabilities related to prior authorization
• Take accountability for accurate translation of reporting requirements for Capital Rx’s customers 
• Support analytics and reporting needs for the prior authorization team and related groups
• Own swift resolution and clear communication of critical reporting issues
• Present analysis results clearly
• Assist in testing of new Judi functionality to ensure enhancements are functioning as expected and accurately processing claims transactions
• Build key cross-functional relationships with other internal teams
• Provide virtual and in person product demonstrations
• Note: Role may periodically require meeting participation, service support or other requirements outside of standard business hours

Minimum Qualifications:

• Bachelor’s degree, with record of strong academic performance in Computer Science, Actuarial Science, Statistics, or Economics or equivalent work experience strongly preferred
• 2+ years of proven experience in data analytics and reporting required
• 2+ years of experience in Structured Query Language (SQL) required
• 2+ years of experience with ETL or ELT preferred
• 2+ years of PBM, pharmacy, health plan, or related experience preferred
• 1+ years working with JSON or other data-exchange format tools preferred
• 1+ year of Python, R, or similar programming experience preferred
• Experience presenting analysis to clients and/or management preferred
• Proficient in Microsoft Excel
• Extremely organized, detail-oriented, and able to easily pivot priorities
• Ability to work effectively with virtual teams
• Ability to travel 5-10%