Data Exchange Analyst - Claims Operations
About The Position
The Data Exchange Analyst plays a key role in ensuring the accuracy, reliability, and smooth operation of data feeds that support JUDI Rx’s pharmacy benefit services. This role is responsible for executing and monitoring outbound eligibility, claims, formulary, and network reporting; supporting manual claims activities; assisting with custom data feed configurations; and participating in historical data loads and connectivity setups for JUDI Rx clients. The Analyst works closely with internal teams and external partners to maintain, troubleshoot, and optimize data exchange processes. Success in this role requires strong PBM data knowledge, advanced analytical skills, a proactive problem-solving mindset, and the ability to communicate effectively across technical and non-technical audiences.
Requirements
- Bachelor’s degree required.
- 1+ years of experience in PBM, healthcare data operations, or IT integration roles.
- Strong understanding of PBM data (eligibility, claims, accumulators, formulary, network) and file layouts.
- Strong analytical and root-cause problem-solving skills.
- Proficiency in SQL, Excel, and other data manipulation tools preferred.
- Strong communication skills with the ability to collaborate across technical and business teams.
- Detail-oriented, self-motivated, and able to manage multiple priorities in a fast-paced environment.
- Experience working with data feeds, EDI, or system integrations strongly preferred.
Responsibilities
- Develop, validate, and maintain outbound data feeds (claims, formulary, network, eligibility) to ensure accuracy and alignment with JUDI Rx standards.
- Assist in setting up and testing data connectivity for new and existing clients.
- Support manual claims processing activities, including error resolution and specialized claim scenarios, as directed by the Data Exchange leadership team.
- Execute and support historical data loads and related data preparation tasks.
- Investigate, troubleshoot, and resolve data transfer and loading issues, partnering with internal teams and external integration partners.
- Monitor system status, dashboards, and data movement to detect anomalies or trends that may impact data quality or timeliness.
- Ensure all issues are resolved in accordance with established procedures, quality standards, and defined SLAs.
- Perform regular audits and data reconciliations to validate accuracy across JUDI and downstream systems.
- Work collaboratively with Client Operations, Implementation, Product, and Development teams to support onboarding, migrations, vendor changes, and data-related client requests.
- Act as a liaison to ensure clear communication of data requirements, issue status, and impacts across internal stakeholders.
- Translate business needs into clear data requirements or configuration updates, escalating complexity or risks to leadership as appropriate.
- Recommend opportunities for process automation, quality improvement, and enhanced efficiency within the Data Exchange function.
- Create and update process documentation, SOPs, and configuration guidelines to support the consistency of JUDI operational workflows.
- Contribute to internal knowledge sharing and support training efforts for new team members.
- Maintain awareness of Medicare, Medicaid, and state regulatory requirements related to data exchange and ensure adherence to all compliance standards.
- Follow all JUDI Rx data governance practices, HIPAA guidelines, and security protocols.
- Adhere to the JUDI Rx Code of Conduct, including timely reporting of potential noncompliance.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
