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

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 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

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

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

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: 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:

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

We are seeking a highly analytical and detail‑oriented Analyst to join our team. This role plays a key part in validating and coding audit deliverables, developing performance monitoring reporting, quantifying financial impact, and driving efficiency through automation and advanced analytics. The ideal candidate brings experience with internal controls, audit testing, and risk assessment, along with a proven ability to deliver high‑quality results in a fast‑paced, collaborative environment.

Position Responsibilities:

• Research and analyze pharmacy claims to ensure accuracy and contractual compliance across benefit setup, pricing, and guarantees
• Perform audit risk assessments, annual logic reviews and ongoing monitoring activities
• Analyze, reconcile and validate large datasets across multiple internal systems; develop and maintain SQL/Python queries for audit reporting and performance monitoring
• Create audit deliverable reporting, quantify financial impact of potential and confirmed audit findings, and build dashboards to identify trends and risks
• Identify and implement automation and process improvements across audit, reporting, and reconciliation workflows
• Maintain and enhance code, reporting tools, and dashboards to improve reliability, efficiency, and scalability
• Define and document technical requirements, data specifications, and methodologies to support transparency and repeatability
• Collaborate with internal and technology teams to improve data quality, workflows, and controls
• Provide ad-hoc analysis to support evolving business and audit needs
• Responsible for the adherence to the Capital Rx Code of Conduct including reporting of noncompliance

Required Qualifications:

• Bachelor’s degree in a quantitative or business-related field (e.g., Actuarial Science, Statistics, Economics, Finance, Data Analytics, or Business Administration)
• 2+ years of of experience in data analytics, audit, or a related role
• Experience in healthcare, PBM, or pharmacy claims; knowledge of pharmacy benefits, pricing, guarantees, and pharmacy claims analysis preferred
• Proficiency with SQL (Snowflake preferred), Excel, Tableau
• Familiarity with Python and project management/version control tools (e.g., Jira, Confluence, GitHub)
• Strong attention to detail with an intellectual and professional curiosity along with a passion for continuous improvement
• Track record of leading cross-functional initiatives, driving high performance, meeting deadlines, and executing on deliverables
• Effective communicator with both technical and non-technical stakeholders
• Extremely flexible, highly organized, and able to shift priorities easily