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:
Capital Rx is looking for a results-driven Account Coordinator, PBM to support the PBM Commercial account teams with large and jumbo commercial clients in the health system, employer, labor/union, and public sectors. In this role, you will partner with account teams to enhance client satisfaction and help with day-to-day tasks. You’ll collaborate with internal teams to meet the needs of our clients and their members. If you’re passionate about building strong client relationships, navigating healthcare trends, and improving processes, we want to hear from you!
Position Responsibilities:
- Support implementation and client management teams with all day-to-day client requirements
- Responsible for timely and accurate management and execution of all client benefit requests, including benefit changes, eligibility changes, and new implementations
- Analyze incoming client requests and work with internal and external teams to complete required plan documentation
- Support implementation of new plans, pricing, and networks, consistent with strategic or administrative intent
- Lead pre- and post-implementation quality assurance and testing to validate coding accuracy
- Lead claim reviews to proactively identify discrepancies or inaccuracies and develop solutions to address
- Handle and resolve sponsor and member issues, escalating as needed
- Research and respond to claims processing and system configuration inquiries
- Coordinate integration of other data inputs into client management processes
- Collaborate cross functionally to support general client operations, as required
- Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance
Required Qualifications:
- Undergraduate bachelor’s degree, with record of strong academic performance or equivalent job experience
- 1+ years of proven experience in PBM / health plan, benefits consulting, healthcare
- Track record of building trusting internal and external relationships
- Track record of leading cross-functional initiatives, driving high performance, meeting deadlines, and executing on deliverables
- Experience working with structured and unstructured data
- Proficient in Microsoft Office, SQL a bonus
- Ability to balance multiple complex projects simultaneously
- Exceptional written and verbal communication skills
- Extremely flexible, highly organized, and able to shift priorities easily
- Attention to detail & commitment to delivering high quality work product
Nothing in this position description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.
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.
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