Pharmacy Pricing Appeals Analyst

Judi Health • Denver, CO

1d • $23 - $34 • Hybrid

About The Position

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 Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single,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. 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 www.judi.health.

Requirements

• Minimum 2 to 4 years of PBM, pharmacy operations, pharmacy claims, pharmacy reimbursement, network operations, or healthcare claims experience.
• Direct experience researching, validating, or resolving pharmacy claims.
• Experience in reviewing pharmacy claim data, adjudication results, Rx numbers, NDC’s and pharmacy identifiers, invoice documentation, and operational records with strong accuracy.
• Experience working with claims tracking tools, workflow tickets, spreadsheets, and operational documentation.
• Working knowledge of pharmacy reimbursement concepts and PBM claims processes.
• Intermediate to advanced Microsoft excel skills, including accurate data entry, filtering, sorting and working with templates.

Nice To Haves

• Certified Pharmacy Technician [CPhT] preferred, but not required.
• Intermediate coding experience preferred, but not required.
• Retail, specialty, mail-order, managed care or PBM pharmacy experience.
• Experience with pharmacy pricing, network reimbursement, MAC appeals, acquisition cost review, or related pharmacy reimbursement processes.
• Experience using internal pharmacy adjudication systems, reporting, or data output tools to support claims research.
• Experience with compliance-driven operational processing and documentation standards.

Responsibilities

• End-to-end intake, review, investigation, documentation, and processing of pharmacy pricing appeals.
• Support timely and accurate appeal resolution by validating pharmacy appeal requests.
• Research PBM and pharmacy claims.
• Review invoices and acquisition cost documentation.
• Analyze reimbursement outcomes.
• Document appeal decisions.
• Maintain appeal records in tracking systems and workflow tools.
• Claims Investigation – Ability to research pharmacy claim details, validate identifiers and document findings.
• Analytical Thinking – Ability to compare pharmacy claim payment data against invoice and acquisition cost.
• Pharmacy Claims Knowledge – Understanding of PBM and pharmacy claims terminology, adjudication, and reimbursement concepts.
• Communication – Clear written and verbal communication with internal stakeholders and pharmacy contacts.
• Data Integrity – Commitment to accurate, complete and audit ready records.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree