Customer Success Consultant - Medicare Advantage

Location: Hybrid (NYC)

Position Summary:

Capital Rx is seeking a self-driven Customer Success Consultant to support the development Medicare Advantage Medical claims processing in Judi, Capital Rx’s enterprise health platform.

The ideal candidate will have hands on experience with Medicare medical claims processing, having worked closely and been involved in Medicare Advantage or Medicare Fee For Service Part A and Part B claim administration. The candidate will have comprehensive and thorough knowledge of the Medicare Managed Care Manual that describes the policies applicable to Medicare claims processing programs.

In year one, this individual will help guide the build-out of infrastructure to support industry-standard benefit configuration and claims adjudication logic.

In year two and onwards, this individual will be responsible for managing and servicing new and existing Medicare Advantage clients of Judi’s Unified Claims Processing platform. This individual will be expected maintain an in-depth understanding of the evolving capabilities of Judi and dive into client requirements to identify how to best configure their benefits in Judi. Exceptional communication skills and attention to detail are critical for communicating with clients in a manner that facilitates their ability to successfully adopt our tools into their own medical benefit management and claims processing workflows.

Position Responsibilities:

• Partner with product managers and directors operating in an agile framework to conceptualize and break down functional and non-functional requirements needed to be the market leading offering within Judi.
• Configure, test and validate Medicare Advantage medical benefits in Judi
• Build and maintain trusting relationships with clients through superior customer service. Provide oversight of the clients ongoing use of Judi.
• Accountable for accurate and timely transition of new clients into the Judi platform.
• Lead communications throughout the implementation process, including, but not limited to, detailed and strategic guidance for benefit builds, accumulations feeds, network build, and complex claim situations/requests.
• Proactively identify execution risks and mitigation strategies.
• Provide ongoing client support to troubleshooting inquiries.
• Understand and manage requests for new features in alignment with the product roadmap.
• Identify and drive efficiencies to increase rate of adoption in market.
• Provide virtual and in-person product demonstrations to prospective clients with the ability to sell product differentiators and resonate with current operational challenges.
• Certain times of year may require meeting participation, 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 strongly preferred
• 5 years of work experience at a Medicare Advantage health plan or TPA handling Medicare Advantage business
• Well-versed in CPT, ICD-10, HCPCS codes
• Medicaid experience preferred
• 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.
• 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.

Base Salary: $80,000 - $110,000

Nothing in this position description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

About Capital Rx

Capital Rx is a full-service pharmacy benefit manager (PBM) and pharmacy benefit administrator (PBA), advancing our nation’s electronic healthcare infrastructure to improve drug price visibility and patient outcomes. As a Certified B Corp™, Capital Rx is executing its mission through the deployment of JUDI®, the company’s cloud-native enterprise health platform, and a Single-Ledger Model™, which increases visibility and reduces variability in drug prices. JUDI connects every aspect of the pharmacy 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 pharmacy 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.

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Salary : $80,000 - $110,000