Capital Rx

• Responsible for taking incoming requests for first, second level and external appeals while ensuring high level of customer service and maximizing productivity. • Work with appeals team for multiple lines of business such as Commercial, Exchange and Medicare, ensuring the proper submission of appeals for review by pharmacist and medical directors. • Maintain quality and productivity standards for all cases reviewed while meeting established turnaround time requirements. • Remain current on all communications and updated processes relayed through multiple communication channels and apply to daily responsibilities. • Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and policies. • Review all cases received, to verify if case meets qualifications for appeal review. • Performs triple check to ensure quality reviews and handling in accordance with policies and procedures. • Updates case types, sends appeal acknowledgements, and submits case information to independent review organizations. • Communicate effectively with appeal pharmacists regarding internal and external appeals. • Make verbal outreach attempts to obtain necessary information for case review and record accurate information obtained on the call. • Exhibit excellent phone and communication skills while providing complete and accurate information to members and providers. • Performs all other related duties as assigned

• Medical Director will complete assigned medication utilization reviews (PA) and/or medical necessity appeals for commercial clients; governmental (Medicare/Medicaid) programs and individual client requested coverage determinations or appeals when appropriate • Makes clinical determinations in accordance with medical necessity and criteria • Performs scientific literature evaluation using primary, secondary, and tertiary drug resources to support decision-making and recommendations to requesting prescribers • Follow all internal procedures, job aids, and HIPPA guidelines to protect patient privacy and data security • Support the Department’s responsibilities to provide peer-to-peer phone call support to physicians/prescribers who call the company with specific and general questions about our clinical programs, communications and utilization review decisions • Communicates effectively and confidently with members to promote positive health outcomes • Actively participates in the development of utilization management (PA) criteria and clinical policy revisions/reviews • Ability to work in a fast-paced environment with shifting priorities • Weekend on-call responsibilities (shared rotating call) • Attention to detail and commitment to delivering high-quality work

• Lead live product demos and facilitate trainings for clients during implementation and post-launch, ensuring stakeholders understand how to effectively use the platform. • Translate product workflows and functionality into clear, engaging training sessions and documentation tailored to different client audiences. • Create, maintain, and continuously improve documentation, including user guides, training decks, FAQs, and knowledge base content. • Configure client-specific portals within Judi and support user acceptance testing (UAT) to ensure successful implementation and launch. • Submit and track product enhancement and development requests, partnering closely with Product to communicate client needs, validate use cases, and support prioritization. • Coordinate and track large-scale client migrations, including maintaining migration plans, status tracking, dependencies, timelines, and stakeholder communication. • Serve as a primary point of contact for clients to triage questions, issues, and feedback, and provide 1/1 client go-live support. • Partner closely with Product teams to stay current on roadmap priorities, feature changes, and workflows, and collaborate with the Implementation and Account Management teams to align on operational impacts and client needs. • Act as a trusted Judi Care product expert in client meetings and cross-functional workstreams. • Contribute to scalable implementation efforts by helping standardize training approaches, materials, and client-facing processes. • Provide input into release readiness by assisting with testing, drafting release notes, and anticipating client training needs. • Enable internal teams (Sales, Customer Success, Support) with Judi Care product knowledge and training resources as needed.

• Lead, mentor, and scale a high-performing cloud security engineering function, fostering strong ownership, operational excellence, and continuous improvement. • Own execution of the cloud security roadmap, prioritizing initiatives across FedRAMP readiness, zero trust architecture, cloud hardening, security automation, and continuous control validation. • Define and evolve the cloud security strategy for Judi Health, aligning technical investments and security architecture decisions to business growth, regulatory commitments, platform resilience goals, and emerging AI initiatives. • Serve as a trusted advisor to the CISO, engineering leaders, and executive stakeholders, helping drive secure-by-design decisions and modern security engineering practices across the organization. • Lead the design, implementation, and continuous improvement of cloud security controls across AWS infrastructure, platforms, application environments, and supporting services. • Identify, prioritize, and drive remediation of security risks across cloud services, infrastructure as code, third-party integrations, developer workflows, and enterprise platforms. • Build and operationalize cloud security capabilities that support compliance with frameworks and customer obligations including FedRAMP, FISMA, SOC 2, HITRUST, HIPAA, and related control requirements. • Drive threat detection, incident response readiness, vulnerability management, penetration testing, and security validation efforts to proactively identify and reduce risk. • Advance automation for security monitoring, alerting, evidence collection, and policy enforcement to improve scalability and support continuous compliance. • Establish meaningful security metrics and reporting for cloud posture, control effectiveness, and roadmap progress, and communicate insights clearly to senior leadership. • Partner with software engineering, platform engineering, DevOps, IT, and AI teams to embed security into architecture, infrastructure, the software development lifecycle, and AI-enabled capabilities. • Work closely with compliance, legal, privacy, and risk management teams to translate regulatory and customer requirements into practical, auditable technical controls. • Lead technical engagement for third-party assessments, customer security reviews, and external audits, ensuring strong preparation, evidence readiness, and timely remediation. • Help define and operationalize a modern security framework for AI initiatives, including governance, data protection, access controls, third-party risk, and secure adoption practices.

• Design, develop, and publish Tableau dashboards and data visualizations in Tableau Cloud/Server to support client reporting and internal analytics. • Translate stakeholder requirements into clear, well-structured dashboards, optimizing usability (filters, parameters, navigation) and ensuring consistency of metric definitions. • Package, version, and document in Confluence and GitHub; follow established branching and review practices. • Own the ongoing health and evolution of Tableau reporting assets, including standardization, metric integrity, and user experience improvements across teams. • Implement lightweight data quality checks and validation steps to confirm measures and dimensions are accurate and aligned to governed definitions. • Coordinate updates and releases with the Analytics Platform team, including change notes and stakeholder walkthroughs. • Develop efficient data sources and queries for Tableau using Snowflake; apply best practices for extracts vs live, row-level security, and query optimization. • Monitor dashboard performance and usage, iterating to reduce load times and improve responsiveness • Partner with Analytics Engineering on data modeling and definitions as needed for Tableau consumption. • Collaborate with Client Services and business stakeholders to translate business questions into reporting requirements, iterate on solutions, and run demos to gather feedback and drive continuous improvement. • Provide training and support for power users and business users adopting new dashboards. • Contribute to a culture of data-driven decision-making across teams. • Responsible for adherence to the Capital Rx Code of Conduct, including reporting of noncompliance.

• Intake product requests from operations stakeholders and clients. • Triage, research and identify technical solutions for data errors occurring within the Judi Health tech stack. • Work with operations and implementation teams to manage issue prioritization and resolution. • Collaborate with the APM to build business requirements and specifications for road mapped items as directed by the APM. • Responsible for ticket review and identification of misintent post QA. • Identify and make data driven recommendations to APM for high value product enhancements. • Assist product team with user experience testing, research, documentation, and stakeholder communication. • Partner with APM to manage backlog and participate in team refinement & planning. • Provide support to the APM and team in terms of planning, roadmap development, and long-term strategy. • Responsible for adherence to the Judi Health Code of Conduct including reporting of noncompliance.

• Ensures state and federal regulatory compliance filings and government regulations, ensuring benefits and leave programs adhere to applicable laws. • Performs regular financial reviews of benefit carrier billing to ensure the accuracy of invoices and enrollment compared to change files, vendor systems, inputs, and payroll. • Provide day-to-day benefits support, assisting employees in navigating their benefits needs. • Ensures the accuracy of all benefits enrollments in the HRIS to provide vendors with accurate eligibility information. • Leads new-hire orientation benefit sessions. • Performs quality checks of benefits-related data. • Understands self-insured benefits plans and stop loss. • Manage, review, validate and process life status changes. • Serve as point of contact for benefits inquiries from employees on plan provisions, benefits enrollments, status changes and other general questions. • Oversees leave-of-absence and disability requests. • Effectively interprets FMLA, ADA and state leave implications as they relate to leaves of absences/disabilities. • Manages the open enrollment process. • Provides necessary reports for allocation/billing charges. • Document and maintain administrative procedures for assigned benefits processes. • Prepares special reports by collecting, analyzing and summarizing information and trends. • Maintain up to date materials for benefits vendors on company intranet. • Assist with the maintenance and testing of the HRIS and other systems and with benefits and wellness initiatives. • Conduct regular audits to ensure the accuracy and completeness of benefits data, making necessary corrections and updates. • Stay informed about changes in benefit trends, laws and regulations, ensuring ongoing compliance and timely adjustments to policies. • Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance.

• Thoroughly understand all Underwriting and Rebate Administration data sources, fields, and relationships, including historical claims, Medi-Span tables, NCPDP tables, and Capital Rx’s Book of Business data to interpret trends, identify patterns, and conduct complex data analyses in support of Underwriting, Rebate Administration, and Sales business goals • Investigate new data sources for the purpose of building & maintaining data pipelines to clean, transform, and aggregate disparate data • Use agile software development to create, maintain, and improve back-end systems for data extracts, pricing processes, and analytic tools to advance the department’s technical capabilities • Model front-end views and back-end data sources to draw a comprehensive picture of the user experience and analytic pipelines throughout the system and to enable powerful data analysis • Troubleshoot and customize infrastructure code in SQL, R, and Python to diagnose and solve data or process issues • Work closely with our Underwriting and Clinical teams to help build complex algorithms that provide useful insights into our data • Assist in the analysis and development of new models and front-end tools that can be used to make predictions and answer questions for financial modeling & reporting • Collaborate with various teams across the company on data sources and analytic methodology in support of Underwriting, Rebate Administration, and company objectives • Provide standard and ad-hoc analytics to support the Underwriting and Rebate Administration teams for the successful completion of bid opportunities and rebate payment management

• 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. • Develop and implement data validation rules and processes to ensure the accuracy, completeness, and consistency of exchanged data. • Proactively monitor system status and Data Exchange management data to quickly identify potential abnormalities that might impact quality and accuracy. • Analyze data trends to identify potential issues or areas for improvement.

• Lead the development and deployment of cutting-edge solutions from design to production. • Collaborate with product managers and cross-functional teams to refine and implement requirements, ensuring seamless integration and user experience. • Engage with major clients and cross-functional teams to architect innovative solutions and enhance product functionality. • Establish and maintain consistent, enterprise-grade APIs across services, ensuring interoperability and scalability while employing best practices for interactions with both partner and internal systems. • Build robust backend applications in Python on AWS Lambda, API Gateway, SMS, ECS, and other cloud technologies. • Implement backend code in a serverless, cloud-native environment (Flask/AWS Lambda/ECS). • Design and implement scalable systems capable of handling high-volume transactions, ensuring robustness and reliability. • Ensure security best practices are followed in all aspects of development and deployment. • Conduct code reviews to maintain high code quality and standards. • Demonstrate technical leadership, driving timely execution and high-quality software delivery. • Make informed architectural decisions through careful evaluation and leveraging prior experience. • Self-manage tasks, collaborate effectively with both internal and external teams, and drive projects to successful completion. • Represent the software development team’s products to stakeholders, providing technical insights and solutions.