Sr. Lead Provider Network Onboarding and Integration Capital Rx LLCSr. Lead Provider Network Onboarding and IntegrationNew York, NY$174,800–$218,500 / yearBy 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. The Senior Lead Provider Network Onboarding and Integration will play a critical role in supporting the expansion of the TPA business by leading the onboarding, integration, and operational enablement of national, regional, direct contract provider networks and network aggregators.
Sr. Lead, Payer Gateway Management Capital Rx LLCSr. Lead, Payer Gateway ManagementNew York, NY$174,800–$218,500 / yearPosition Responsibilities: Oversee payer gateway and clearinghouse operations supporting HIPAA EDI transactions, including 837 claims, 270/271 eligibility, 276/277 claims status, 835 remittance/payment support, acknowledgments, rejects, and related file exchanges. This role ensures accurate, timely, and compliant processing of HIPAA EDI transactions and hosted gateway solutions supporting claim submissions, eligibility verification, claims status checks, acknowledgments, rejections, file reconciliation, and production issue resolution.
Formulary Operations Pharmacist Capital Rx LLCFormulary Operations PharmacistNew York, NY$125,000–$135,000 / yearThis role will help maintain and expand clinically appropriate low-cost alternative opportunities, support program reporting and performance tracking, and partner cross-functionally to improve workflows that drive savings for members and plan sponsors. Analyze claims data, test claim results, opportunity volume, savings outputs, and intervention results to monitor program performance, identify trends, and support dashboard creation and maintenance for the low-cost alternative program and other formulary-focused initiatives.
Analyst, Data Exchange Medical, Dental & Vision Capital Rx LLCAnalyst, Data Exchange Medical, Dental & VisionNew York, NY$96,800–$121,000 / yearPosition 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. 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.
Senior Manager Government Program Operations Exchange Capital Rx LLCSenior Manager Government Program Operations ExchangeNew York, NY$155,000–$165,200 / yearJudi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including: Capital Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers, Judi Health, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and. Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including: Judi Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers, Judi Health, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and.
Principal, Provider Data Management Capital Rx LLCPrincipal, Provider Data ManagementNew York, NY$144,800–$181,000 / yearThis position operates at a senior individual-contributor level: leading governance design, resolving complex data issues, strengthening claims-pricing defensibility, mentoring operational teams, and driving sustainable improvements across provider data intake, maintenance, quality, audit readiness, and downstream consumption. 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.
Field Auto Appraiser - Hempstead, NY Allstate Insurance CompanyField Auto Appraiser - Hempstead, NYHempstead, NY$60,000–$117,700 / yearAppraisal Management, Appraisal Process, Audatex Estimating, Auto Collision (Inactive), Auto Detailing, Auto Estimating, Automobile Maintenance, Automotives, Car Maintenance, CCC ONE, Cost Estimates, Estimation Techniques, Insurance Appraisal, Insurance Repairs, Insurance Valuation, Mitchell Estimating, Negotiation, Repair Estimating, Written Communication. This role offers a sign on bonus of $1,000 if you have an active appraiser license or active adjuster license in TX, FL, or your resident state (current employees and candidates who have previously worked for and are seeking to be rehired at Allstate and its family of companies are not eligible for this sign-on bonus).
HealthCare Claims Analyst Village CareHealthCare Claims AnalystNew York, NY$65,294.40–$72,277 / yearFull timeYou will play a critical role in understanding healthcare reimbursement from both financial and operational perspectives, conducting audits, and performing root cause analysis to resolve identified issues with internal teams and third-party administrators (TPAs).This position involves identifying gaps in various aspects of claims processing, communicating trends and contract issues to management, and preparing comprehensive narratives and visual aids for leadership presentations. - $72,277**SQL CODING EXPERIENCE REQUIRED** A little about usVillageCare is a community-based, not-for-profit organization serving people with chronic care needs, as well as seniors and individuals in need of continuing care and managed care services.
Director, Payment Integrity Capital Rx LLCDirector, Payment IntegrityNew York, NY$206,400–$258,000 / yearPosition Summary: The Director, Payment Integrity will build and lead Judi Health''s payment integrity program from inception, establishing the infrastructure, processes, and team that will ensure claims are paid correctly, compliantly, and efficiently across our commercial plan population. 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.
Inpatient Coder Associate, Payment Integrity Clover Health Investments CorpInpatient Coder Associate, Payment IntegrityNYRemote$80,000–$110,000 / yearSuccess in this role looks like: By the end of your initial 90-day period, you will have demonstrated a strong understanding of clinical coding practices and medical records review, while assisting our team in areas of DRG validation. We believe the healthcare system is broken, so we''ve created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.
Trainer I Blue Cross and Blue Shield AssociationTrainer INewark, NJ$56,200–$75,285 / yearThis compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This position is responsible for delivering service training programs across enterprise sites and remote vendor locations while supporting the development and continuous improvement of learning solutions.
Dental Billing Specialist scotchplain fanwood sdentalcareDental Billing Specialistfanwood, NJFull timeThe ideal candidate will be responsible for handling billing and insurance claims, processing patient payments, verifying insurance benefits, and supporting front office operations. This role is essential to ensuring accurate and timely financial transactions and maintaining excellent patient communication regarding billing matters.
Orthodontic Coordinator ProSmileOrthodontic CoordinatorParlin, NJ$22–$25 / hourOur premier DSO is led by world class dentists who understand what highly skilled dentists and dental professionals need to grow a practice while focusing on delivering the best-in-class clinical care to their patients. We offer the following benefits for Full Time Benefits Eligible Positions (35+ hours per week) and Part Time Benefits Eligible Positions (30-35 hours per week): Medical Insurance: Choice of five comprehensive Aetna medical plans, including options with low copays, deductible-sharing, and national provider networks.
RCM Accts Receivable Coor OB Hospitalist Group IncRCM Accts Receivable CoorNYRemote$24–$26 / hourThis position plays a critical role in improving reimbursement outcomes, reducing accounts receivable aging, supporting payer enrollment activities, and driving operational excellence across the revenue cycle. Location: Candidates residing in the Upstate South Carolina area are preferred for this remote position and should be within reasonable commuting distance of our Greenville, SC Corporate Headquarters to accommodate occasional in-office needs as requested.
Senior Claims Examiner, Professional Lines Coaction Specialty Insurance GroupSenior Claims Examiner, Professional LinesMorristown, New JerseyLeveraging deep technical expertise and a strategic mindset, you will oversee the full claims lifecycle—ensuring high-quality investigations, timely resolution, and alignment with corporate objectives, regulatory requirements, and Coaction’s claim handling guidelines. Salary range specific to for this role: $103,000-$168,000 + discretionary incentive bonus + benefits depends on various factors including, without limitation, individual and organizational performance.
Senior Claims Examiner, Professional Lines Coaction Specialty Insurance Group IncSenior Claims Examiner, Professional LinesMorristown, NJLeveraging deep technical expertise and a strategic mindset, you will oversee the full claims lifecycle-ensuring high-quality investigations, timely resolution, and alignment with corporate objectives, regulatory requirements, and Coaction's claim handling guidelines. Salary range specific to for this role: $103,000-$168,000 + discretionary incentive bonus + benefits depends on various factors including, without limitation, individual and organizational performance.
Manager, Government Programs Enrollment Capital Rx LLCManager, Government Programs EnrollmentNew York, NY$146,000–$182,500 / yearBy 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. Position Summary: The Government Programs Enrollment Manager is responsible for the implementation, overall management, oversight and continuous improvement of Medicare enrollment and eligibility operations for the Health Plan EGWP line of business.
Specialist, Business Systems Analyst II Blue Cross and Blue Shield AssociationSpecialist, Business Systems Analyst IINewark, NJ$109,600–$149,625 / yearServe as the primary Business Systems Analyst for Blue Card, BlueCard Modernization (BCM), National Program Releases (NPR), Inter-Plan Teleprocessing System (ITS), Blue2, BlueCard Portal, RTM, and related BCBSA initiatives. This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity.
Staff Product Manager, Claims Experience Coalition IncStaff Product Manager, Claims ExperienceNYAs a Staff Product Manager for our Claims Experience, you will own the systems and workflows at the heart of that promise: making our claims handling faster, smarter, and more effective for the internal teams who run it and the brokers and policyholders who depend on it. Develop and maintain a clear product strategy and roadmap for Coalition''s claims experience, with a strong emphasis on operational efficiency spanning workflow tools, automation, ML-powered insights, and customer-facing experiences.
Wholesale Account Services Specialist Tapestry, Inc.Wholesale Account Services SpecialistNorth Bergen, NJ$60,000–$70,000 / yearOrder Management/Reporting/Analysis Activities: Review and maintain orders through the order management system (SAP) from the time of receipt to the time of shipment which includes post market activities, ownership of order status, executing order book changes based on business/customer needs and monitoring shipment flow to mitigate any risk to revenue for the month/quarter. Building Effective Teams: Blends people into teams when needed; creates strong morale and spirit in their team; shares wins and successes; fosters open dialogue; lets people finish and be responsible for their work; defines success in terms of the whole team; creates a feeling of belonging in the team.