Staff Analyst, Analytics - Pharmacy Payment Integrity & Analytics

Judi Health•Charlotte, NC

26d•Hybrid

About The Position

Judi Health is a health technology company that provides benefit administration solutions through a unified claims-processing platform. The Staff Analyst will join the Analytics team to support pharmacy claims integrity, adjudication validation, and operational excellence. The role uses SQL and large-scale pharmacy claims data to investigate claim outcomes, identify discrepancies, validate benefit and pricing configurations, and confirm accurate adjudication in accordance with contractual and regulatory requirements. The analyst will work with Finance, Legal, Product, Operations, Network, Compliance, and other stakeholders to investigate issues, quantify impacts, support audits, and improve processes. The position helps protect financial accuracy, mitigate risk, and support a high-quality member and pharmacy experience. The role is hybrid, with three in-office days, and offices in the New York City, Denver, and Charlotte, North Carolina areas. Employees are responsible for following the Judi Health Code of Conduct, including reporting non-compliance. Duties may be reassigned as needed to meet organizational goals. Judi Health provides equal employment opportunities and prohibits discrimination and harassment on legally protected grounds.

Requirements

4–6 years of experience in healthcare analytics, pharmacy analytics, PBM operations, claims auditing, or a related field.
Advanced SQL skills and the ability to analyze large, complex datasets.
Experience performing pharmacy reimbursement, network pricing, financial reconciliation, contract compliance, or payment-integrity analysis.
Ability to interpret complex contractual pricing terms and convert them into documented calculations, validation rules, and analytical test cases.
Experience investigating discrepancies across claims, pricing reference data, contract terms, adjudication logic, and financial outputs.
Ability to quantify financial exposure and communicate material findings, assumptions, and limitations to Finance, Legal, Network, Product, and executive stakeholders.

Nice To Haves

PBM industry experience.
Experience with pharmacy network contracting, reimbursement analysis, effective-rate reconciliation, or contract compliance.
Experience using drug reference and pharmacy reference data.
Familiarity with financial controls, audit support, accrual processes, recoveries, or materiality assessment.
Experience creating automated exception monitoring and reconciliation frameworks.

Responsibilities

Use SQL and other analytical tools to review pharmacy claims data and validate adjudication outcomes.
Investigate claim pricing, benefit application, reimbursement calculations, accumulators, and other claim-processing logic to identify discrepancies or errors.
Perform root cause analyses on adjudication issues and partner with stakeholders to develop corrective actions.
Develop repeatable monitoring and surveillance processes to identify anomalies, trends, and potential financial or operational risks.
Collaborate with Finance, Legal, Product, Operations, Network, and Compliance teams to interpret requirements and assess claim-processing outcomes.
Support audits, regulatory reviews, contractual validations, and financial reconciliations through detailed claims analysis.
Translate technical findings into clear, actionable recommendations for business stakeholders.
Participate in cross-functional discussions to evaluate system changes, benefit implementations, and operational processes.
Develop and maintain SQL queries, reports, dashboards, and analytical tools that support claims oversight and operational decision-making.
Ensure analyses are accurate, well-documented, reproducible, and supported by appropriate quality controls.
Identify opportunities for automation and process improvement to increase efficiency and reduce risk.
Help identify and quantify financial, operational, and compliance risks associated with claims processing.
Validate that claims adjudicate in accordance with benefit designs, contractual requirements, and company policies.
Maintain documentation of methodologies, business rules, findings, and remediation activities.
Adhere to the Judi Health Code of Conduct, including reporting non-compliance.