Analyst, Data Exchange Claims Ops (TPA)

<div class="content-intro"><h2><strong>About Judi Health</strong></h2> <p>Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels.<br><br>At Judi Health, we're deploying the infrastructure our country needs to deliver the healthcare we all deserve. We are the intelligence platform powering benefits plans for millions of Americans and proudly leading the next generation of care. To learn more, visit <span><a href="http://www.judi.health" target="_blank">www.judi.health</a></span>.</p></div><p>Location: Hybrid 3 days a week in-office (NYC, Denver, CO or Charlotte, NC) </p> <p><strong><u>Position Summary:</u></strong></p> <p><span class="TextRun SCXW112822126 BCX0" lang="EN-US" data-contrast="none"><span class="NormalTextRun SCXW112822126 BCX0" data-ccp-parastyle="Normal (Web)">The Data Exchange Analyst is a crucial member of our Data Operations team, responsible for ensuring the </span><span class="NormalTextRun SCXW112822126 BCX0" data-ccp-parastyle="Normal (Web)">accurate</span><span class="NormalTextRun SCXW112822126 BCX0" data-ccp-parastyle="Normal (Web)">, efficient, and secure exchange of healthcare data between </span><span class="NormalTextRun SCXW112822126 BCX0" data-ccp-parastyle="Normal (Web)">Capital Rx – JUDI Health</span><span class="NormalTextRun SCXW112822126 BCX0" data-ccp-parastyle="Normal (Web)"> and its various partners, including employers, providers, and other TPAs. This role focuses on the technical aspects of data integration, file transformation, error resolution, and ongoing monitoring of data feeds for medical, dental, and vision claims. The ideal candidate will </span><span class="NormalTextRun SCXW112822126 BCX0" data-ccp-parastyle="Normal (Web)">possess</span><span class="NormalTextRun SCXW112822126 BCX0" data-ccp-parastyle="Normal (Web)"> a strong understanding of healthcare data formats, excellent analytical skills, and a commitment to data integrity and compliance.</span></span><span class="EOP SCXW112822126 BCX0" data-ccp-props="{"134233117":false,"134233118":false,"201341983":2,"335551550":6,"335551620":6,"335557856":16777215,"335559738":0,"335559739":240,"335559740":240}"> </span></p> <p><strong><u>Position Responsibilities:</u></strong></p> <p><em><span data-contrast="none">Data Integration & Mapping: </span><span data-ccp-props="{"201341983":2,"335551550":6,"335551620":6,"335557856":16777215,"335559685":720,"335559739":240,"335559740":240}"> </span></em></p> <ul> <li data-leveltext="" data-font="Symbol" data-listid="7" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="1" data-aria-level="1"><span data-contrast="none">Design, develop, and maintain data mappings and transformations for incoming and outgoing healthcare data files: 837/835 - claims & remittance, 270/271 – eligibility and responses, 278 – Prior Auth, 276/277 – claim status, 999/TA1 – file level acknowledgement as well as proprietary formats</span></li> <li data-leveltext="" data-font="Symbol" data-listid="7" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="1" data-aria-level="1">Collaborate with internal teams (e.g., Client Services, Claims, IT Development) and external partners (e.g., clearing houses or third-party administrators) to define data requirements and specifications</li> <li data-leveltext="" data-font="Symbol" data-listid="7" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="1" data-aria-level="1">Work with business teams and trading partners to onboard, test and certify new connections and transaction sets<span data-ccp-props="{"201341983":2,"335551550":6,"335551620":6,"335557856":16777215,"335559739":240,"335559740":240}"> </span></li> </ul> <p><em><span data-contrast="none">Data Quality & Validation:</span><span data-ccp-props="{"201341983":2,"335551550":6,"335551620":6,"335557856":16777215,"335559685":720,"335559739":240,"335559740":240}"> </span></em></p> <ul> <li data-leveltext="" data-font="Symbol" data-listid="7" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="4" data-aria-level="1"><span data-contrast="none">Develop and implement data validation rules and processes to ensure the accuracy, completeness, and consistency of exchanged data</span></li> <li data-leveltext="" data-font="Symbol" data-listid="7" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","46