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

Position Summary:

As a member of the Enterprise Solutions team, you will pay a critical role in contributing to the success of Capital Rx’s customers leveraging JUDI, our Enterprise Health Platform, to service their own pharmacy administrative needs. The Enterprise Solution team seeks individuals who are passionate to change the landscape of claims processing while providing superior service. The expectations for growth in this role are to push beyond the core subject matter areas of expertise and serve as an expert across all domains of JUDI.

Position Responsibilities:

• Provide configuration services and support of Capital Rx’s Software as a Service (SaaS) customers for migration and ongoing use of JUDI.
• Provide customers with subject matter expertise in JUDI’s capabilities, ensuring successful migration to the adjudication platform, with parity of all plan benefit logic and initiatives.
• Accountable for accurate translation of requirements/setup of plan benefits from previous adjudication systems and configure to the customer’s intent.
• Build and maintain trusting relationships with customers through superior customer service, meeting or exceeded service level metrics.
• Lead communications throughout the implementation period by providing detailed and strategic guidance on plan benefit configuration, including intersection points with network, formulary, clinical and data exchanges.
• Proactively identify execution risks that would inhibit successful launch in JUDI or negatively impact member experience and propose mitigation strategies.
• Identify and make recommendations drive configuration efficiencies for SaaS customers in JUDI.
• Conduct comprehensive testing and review of plan benefit configurations using JUDIs Testing Module.
• Monitor live claims for accuracy.
• Responsible for ongoing customer support for set up for configuration evaluations and troubleshooting inquiries, working directly with customers, vendors, and operations teams to achieve positive outcomes, within the required turnaround times to meet service level agreements.
• Take charge of critical issues or problems to key stakeholders, ensuring swift resolution and communication.
• Create and maintain documentation (including but not limited to, P&Ps, SOPs, user guides and training materials) to support plan benefit configurations in JUDI.
• Provide user training to SaaS customers as needed.
• Provide virtual and in person product demonstrations, with the ability to sell product differentiators and resonate with current operational challenges.
• Certain times of year may require meeting participation, travel, service support or other requirements outside of standard business hours, including weekends.

Minimum Qualifications:

• Bachelors Degree in relevant field or equivalent work experience
• 4 years experience in PBM or Health plan required
• 2 years of plan, network, pricing and clinical configuration experience in a PBM or Health Plan setting, across multiple lines of business.
• 1 years of SQL experience and managing large data sets preferred
• PBM and/or pharmacy technician experience preferred.
• Medicare Part D subject matter expertise in coverage determination and appeals reviews and audits
• Experience operating multiple claims adjudication systems.
• Track record of leading cross-functional initiatives, driving high performance, meeting deadlines, and executing on deliverables
• Exceptional project / time management, prioritization, and organizational skills to ensure customer satisfaction.
• Ability to shift between competing priorities and meet organizational goals
• Proficient in Microsoft office Suite and willing to adapt to software such as Jira, Miro, Confluence, Github, and AWS Redshift
• Excellent verbal, written, interpersonal and presentation skills
• Ability to work effectively with virtual teams
• Ability to travel 5-10%

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.

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