Capital Rx

Manage and grow client relationships in the Pharmacy Benefit Administration market, lead account teams, ensure regulatory compliance, oversee contractual obligations, and drive client retention and growth. | At least 5 years of relevant experience in pharmacy or health plan PBM environment, knowledge of Medicare/Medicaid pharmacy programs, strong client management and communication skills, and ability to lead cross-functional teams. | About Us Judi Health is a health technology company offering a wide range of benefits administration solutions for employers and health plans. This includes Capital Rx, a public benefit corporation that provides full-service pharmacy benefit management (PBM) solutions to self-insured employers; Judi Health™, which offers comprehensive health benefit management solutions for employers, TPAs, and health plans; and Judi®, the industry’s leading proprietary Enterprise Health Platform. To learn more, visit www.judi.health. Position Overview The Account Executive/Strategic Account Executive - PBA Services is responsible for managing the planning, execution, growth & retention and client satisfaction of assigned clients in the Pharmacy Benefit Administration (PBA) market segment including Health Plans, Third Party Administrators (TPAs), and other Platform services. Additionally, this position will lead and collaborate through the broader Account Management team and with internal Capital Rx teams/departments as the client voice and advocate to ensure ongoing client satisfaction and to achieve client priorities and contractual obligations. This position acts as the quarterback and leader of the broader Account Management team who are aligned in support of our clients. This position reports to the Senior Account Executive/Senior Director, PBA Client Services. Position Responsibilities • Work closely with some of our biggest Texas-based clients and manage the complexities of working within a highly-regulated market of the TDI (Texas Department of Insurance) • Provide oversight and direction to the broader Account Management team with a focus on member and client satisfaction, trend management, client growth & retention, and regulatory compliance to meet client specific objectives, client priorities and service model deliverables • Lead and develop the client relationship strategy and the strategic business planning process across the clients in your portfolio while incorporating other internal staff where and when needed to build and foster relationships with influencers and decision makers. • Maintain thorough knowledge and tracking of contractual obligations on assigned book of business, including financials, performance guarantees, terms, and reporting/compliance • Manage and facilitate the Account renewal and contracting process with a focus on client retention and the client financial/PNL management • Serve as the relationship lead on assigned book of business, incorporating other internal staff where and when needed to the relationship; build and foster relationships with influencers and decision makers at the client • Anticipates customer needs and proactively identifies new opportunities within assigned accounts. • Develop and maintain comprehensive knowledge of our business, including products and services to field questions from the client side and to answer timely & accurately • Collaborate with internal teams to customize offerings and solutions, aligning with Health Plan/TPA Account needs and market demands - assemble internal resources to overcomes challenges. • Analyze and interpret current pharmacy and healthcare trends, competitor activities, and industry regulations to inform strategic decisions, provide proactive recommendations for plan management and enhance the company's positioning within the PBA Services segment • Lead, coach and support the Account Team on the effective positioning of the Capital Rx value proposition, our suite of Capital Rx Products and Solutions and JUDI capabilities available to our PBA clients • Partner with our Business Development, Underwriting Teams & Senior Account Executives to support our PBA Account level growth and retention efforts by providing with Capital Rx sales support and market differentiator positioning, including RFP support, Broker/Consultant engagement and Best & Final support for prospective, existing and new and client business development needs • Provide ongoing direction, coordination and coaching to the broader Account Team to align the Account Team understanding of the assigned client(s) business lines, strategies, key stakeholders & decision makers and priorities • Serve as the content expert for Health Plan/TPA clients & opportunities • Identify and help contribute to process improvement efforts • Be accountable & own the client end-to end, inclusive of service model deliverables, contractual negotiations, client escalations and PNL management. • All employees are responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance. Required Qualifications • Bachelor’s or advanced degree in health administration, business, or relevant professional experience. Bachelor of Pharmacy (B.S. Pharmacy) or Doctor of Pharmacy (PharmD) degree from an accredited institution is a plus • Relevant professional experience for at least five (5) years in pharmacy – working within a health plan, managed care, or pharmacy benefits management (PBM) focused on Health Plans and Payer Commercial (Insured, Self-Funded, Exchange) and Government Program (Medicare & Medicaid) business lines. Health plan industry experience highly preferred • Market and operational knowledge of Medicare Part D, Medicaid and Health Exchange pharmacy is required along with experience in supporting highly regulated business lines • Track record of building trust in internal and external relationships • Solution-focused problem solving and client positioning skills • Exceptional written and verbal communication skills • Ability to work with and influence peers in a team effort; leading cross-functional initiatives, meeting deadlines, and executing on deliverables while building strong internal relationships • A decisive individual with sound technical skills, analytical ability, good judgement, and strong operational focus and detail-oriented perspective • Flexible, highly organized, and able to shift priorities easily and work independently to meet deadlines • Ability to effectively work with peers in a team effort • Proficient in Microsoft Office Suite with emphasis on Microsoft Excel and large data sets and other industry software programs • Ability to travel and present to small and large groups; travel is estimated to be up to 25% and be variable by season and business cycle Preferred Qualifications • Experience working with clients who are subject to TDI (Texas Department of Insurance) rules and regulations Salary Range $120,000—$160,000 USD This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. 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.

Provide configuration and support for Capital Rx’s JUDI platform, manage customer inquiries, lead implementation communications, identify risks, and ensure successful claims adjudication and customer satisfaction. | Bachelor’s degree or 4+ years PBM/health plan experience, 2+ years customer-facing role, Medicare Part D expertise, claims adjudication system experience, SQL skills preferred, strong project management, and ability to travel. | About Capital Rx Capital Rx is a health technology company providing claim administration and technology solutions for carriers, health plans, TPAs, employer groups, and government entities. As a public benefit corporation, Capital Rx is executing its mission to materially reduce healthcare costs as a full-service PBM and through the deployment of Judi®, the company’s cloud-native enterprise health platform. Judi connects every aspect of the healthcare 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 benefits and rebuilding trust in healthcare. 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: Serve as the point of contact for all adjudication related inquires in support of Capital Rx’s Software as a Service (SaaS) customers. Provide configuration services and support as needed across multiple modules in JUDI. Provide customers with subject matter expertise in JUDI’s capabilities, ensuring successful migration to the adjudication platform. Accountable for accurate translation of requirements 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 the intersection points of plan benefit configuration, 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 configurations. Monitor live claims for accuracy. Proactivly identify trends and claims discrepancies. Responsible for ongoing customer support for configuration evaluations, 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. Certain times of year may require meeting participation, travel, service support or other requirements outside of standard business hours, including weekends. Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance. Minimum Qualifications: Bachelors Degree in relevant field or 4+ years experience in PBM or Health plan required 2+ years in a customer facing role Medicare Part D subject matter expertise required Experience operating multiple claims adjudication systems 1+ years of SQL experience and managing large data sets preferred PBM and/or pharmacy technician experience preferred 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% Salary Range $90,000—$115,000 USD This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. 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.

Support configuration, validation, and reporting of pharmacy network data within the Judi platform, including data intake, testing, reporting, and customer support. | 1+ year analyst or related role experience, PBM or health plan claims data experience, proficiency in SQL, JSON, Java, R, Excel, strong project management, and ability to work virtually. | About Capital Rx Capital Rx is a health technology company providing claim administration and technology solutions for carriers, health plans, TPAs, employer groups, and government entities. As a public benefit corporation, Capital Rx is executing its mission to materially reduce healthcare costs as a full-service PBM and through the deployment of Judi®, the company’s cloud-native enterprise health platform. Judi connects every aspect of the healthcare 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 benefits and rebuilding trust in healthcare. 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 Network Pricing Analyst supports the configuration, validation, and reporting of pharmacy network data within Capital Rx’s Judi® platform. Strong data skills, experience handling large volume claims data, and the ability to manage multiple priorities are essential. Position Responsibilities • Accountable for accurate translation of network data and reporting requirements of Capital Rx’s Software as a Service (SaaS) customers for migration and ongoing use of JUDI. • Support all network analytics needs of internal team members and customers. • Execute and support existing processes such as, but not limited to: • Assist with intake and conversion of files necessary for parallel Network Validation data review. • Develop Network testing automation. • Support Network and Provider Agreement data reporting, claims analysis, or other network pricing related reporting • Develop and maintain data reporting repositories as it relates to all facets within the network setup. • Perform QA and claims testing to validate that network data loads yield appropriate adjudication results. • Support testing for new JUDI functionality to ensure new enhancements are functioning as expected and accurately processing claims transactions. • Reconcile adjudication output variances with support from network subject matter experts, and maintain data lineage for network configuration data. • Provide customers facing subject matter expertise support on JUDI’s network reporting capabilities. • Contribute to playbooks/templates that scale network configurations for future client onboardings. • Take charge of critical issues or problems to key stakeholders, ensuring swift resolution and communication within service level agreements. • Partner with Analytics colleagues to author automated/manual test cases and monitoring processes for drug coverage configurations and data loads. • Monitor performance metrics (load times, claims accuracy discrepancies) and recommend optimizations. • Certain times of year may require meeting participation, travel, service support or other requirements outside of standard business hours, including weekends.Responsible for adherence to the Capital Rx Code of Conduct, including reporting of noncompliance. Minimum Qualifications • 1+ years of experience in an Analyst role, Software Engineering role or related work experience • 1+ year of PBM or Health Plan operations experience with pharmacy claims data and reimbursement methodologies. • Experience performing complex analyses on large sets of data • Experience working with structured and unstructured data • Proficient in SQL, JSON, Java, R, Excel, and other data visualization tools • 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. • Excellent verbal, written, interpersonal and presentation skills. • Ability to work effectively with virtual teams. • Ability to travel 5-10%. Preferred Qualifications • Bachelor's Degree preferred, or equivalent combination of education, training, and experience. • Experience working with AWS Redshift • Pharmacy Benefit Management analytics preferred Salary Range $80,000—$100,000 USD This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. 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.

Support analytics projects by gathering data requirements, conducting analyses, creating reports and dashboards, collaborating cross-functionally, and ensuring compliance and quality control. | At least 1 year of data analytics experience, proficiency in SQL and BI tools like Tableau, familiarity with scripting languages and cloud data warehouses, strong organizational and communication skills. | About Capital Rx Capital Rx is a health technology company providing claim administration and technology solutions for carriers, health plans, TPAs, employer groups, and government entities. As a public benefit corporation, Capital Rx is executing its mission to materially reduce healthcare costs as a full-service PBM and through the deployment of Judi®, the company’s cloud-native enterprise health platform. Judi connects every aspect of the healthcare 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 benefits and rebuilding trust in healthcare. Location: Hybrid (Local to NYC or Denver Metropolitan areas) Position Summary: We are seeking a highly analytical and detail-oriented Analyst to join our growing Analytics team. This role supports the execution of data-driven projects, reporting initiatives, and business insights. The ideal candidate will have a foundational background in data analysis and a desire to grow technical skills while contributing to cross-functional collaboration and data-informed decision-making. With at least 1–2 years of experience in data analytics, this individual will play a key role in supporting the team’s reporting, analysis, and quality control efforts. Key Responsibilities: Analytical Project Support Assist in the execution of analytics projects by gathering data requirements and preparing reporting deliverables. Conduct exploratory analyses to support program performance, compliance tracking, and utilization trends. Maintain clear and organized documentation of query logic and methodologies to ensure transparency and repeatability. Cross-Functional Collaboration Collaborate with internal teams to support alignment between analytical work and business goals. Participate in meetings with stakeholders to understand project needs and provide data support. Contribute to a culture of data-driven decision-making across departments. Data Analysis and Reporting Use analytical tools to uncover trends and insights from complex datasets. Create dashboards, reports, and visualizations that support operational and strategic initiatives. Maintain and update standard and ad hoc reports with guidance from senior team members. Compliance and Quality Control Support efforts to ensure reporting and analysis meet compliance standards. Participate in quality control reviews and help maintain documentation and consistency across deliverables. Engage in internal training and development to strengthen analytical skills. Responsible for adherence to the Capital Rx Code of Conduct, including reporting of noncompliance. Required Qualifications: At least 1 year of experience in data analytics, business intelligence, or a related field. Exposure to pharmacy claims data, medical claims, or healthcare reporting is a plus. Proficiency in SQL and familiarity with scripting languages such as Python or R. Experience using BI tools such as Tableau or similar platforms. Basic understanding of cloud-based data warehouses (e.g., Snowflake, BigQuery, Redshift) is preferred. Strong organizational skills, attention to detail, and a commitment to producing high-quality work. Effective communication skills, with the ability to explain analytical concepts to non-technical stakeholders. Attention to detail & commitment to delivering high quality work product. Preferred Qualifications: Experience working in large-scale, high-growth organizations. Knowledge of machine learning or advanced statistical modeling techniques. Familiarity with Agile project management methodologies. Bachelor’s degree in Computer Science, Actuarial Science, Statistics, Economics, or a related field. GitHub and DBT experience. Why Join Us? Contribute to a highly skilled, technical analytics team in a dynamic and data-driven organization. Support strategic decision-making and build a scalable data foundation for business growth. Work with cutting-edge technologies and make a meaningful impact on the organization. Salary Range $70,000 - $85,000 USD This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. 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.

Design, develop, and maintain healthcare data mappings and transformations, monitor data quality, troubleshoot data exchange issues, and collaborate with internal and external partners to ensure accurate and compliant data exchange. | Bachelor's degree or equivalent experience, 2+ years in healthcare data analysis or EDI, strong knowledge of healthcare EDI transactions and compliance, proficiency in SQL and Excel, and excellent analytical and communication skills. | Location: Remote Position Summary: The Data Exchange Analyst is a crucial member of our Data Operations team, responsible for ensuring the accurate, efficient, and secure exchange of healthcare data between Capital Rx – JUDI Health 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 possess a strong understanding of healthcare data formats, excellent analytical skills, and a commitment to data integrity and compliance. Position Responsibilities: Data Integration & Mapping: 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 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 Work with business teams and trading partners to onboard, test and certify new connections and transaction sets Data Quality & Validation: Develop and implement data validation rules and processes to ensure the accuracy, completeness, and consistency of exchanged data Proactively identify and resolve data discrepancies, errors, and rejections in a timely manner Perform root cause analysis for data issues and implement preventative measures Monitoring & Support: Proactively monitoring system status and Data Exchange management data to quickly identify potential abnormalities that might impact quality and accuracy Provide technical support and troubleshooting for data exchange issues, working with internal and external stakeholders to resolve problems Document data exchange processes, configurations, and troubleshooting steps Process Improvement & Automation: Identify opportunities to optimize and automate data exchange processes, improving efficiency and reducing manual effort Stay current with industry best practices, new technologies, and regulatory requirements related to healthcare data exchange Reporting & Analysis: Generate reports on data exchange performance, error rates, and key metrics Analyze data trends to identify potential issues or areas for improvement Analyze data trends to identify potential issues or areas for improvement Participate in projects with Data Exchange impacts including vendor changes, client migrations, and client add-on requests Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance. Required Qualifications: Bachelor's degree in Computer Science, Information Systems, Healthcare Informatics, or a related field. Equivalent work experience may be considered Knowledge of healthcare claim adjudication processes for medical, dental, and vision Strong knowledge and familiarity with EDI SNIP validations and one of the most widely used tools in the healthcare industry (e.g., EDIFECS) 2+ years of experience in data analysis, data integration, or EDI (Electronic Data Interchange) specifically within the healthcare industry Strong understanding of healthcare EDI transactions (e.g., 834 Enrollment, 837 Professional/Institutional/Dental Claims, 835 Remittance Advice) Excellent analytical, problem-solving, and critical thinking skills Familiarity with various file transfer protocols (FTP, SFTP, FTPS) Understanding of HIPAA compliance and other relevant healthcare regulations Strong attention to detail and a commitment to data accuracy Ability to analyze complex business problems to discover and resolve root causes Proficiency in SQL, Excel, JSON and other technical data skills preferred Strong communication skills with the ability to develop effective work relationships with internal and external stakeholders Self-motivated and detail-oriented problem solver Ability to handle multiple competing priorities in a dynamic environment and collaborate in a team This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. Salary Range $85,000 - $100,000 USD About Capital Rx Capital Rx is a health technology company providing claim administration and technology solutions for carriers, health plans, TPAs, employer groups, and government entities. As a public benefit corporation, Capital Rx is executing its mission to materially reduce healthcare costs as a full-service PBM and through the deployment of Judi®, the company’s cloud-native enterprise health platform. Judi connects every aspect of the healthcare 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 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.