Senior Manager Government Program Operations (Exchange)

About Judi Health

Judi 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® , the industry’s leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform.

Together with our clients, we’re rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit www.judi.health .

Location: Hybrid (Local to Denver, CO, NYC area or Charlotte, NC)

Position Summary:

The Senior Manager, Government Programs Operations is responsible for the overall implementation, operational oversight, and change management of regulatory requirements for Exchange lines of business. This role leads the delivery of regulatory reporting, claims operations support, audit readiness, and client deliverables, ensuring compliance with federal and state requirements. The person will collaborate with Legal/Regulatory teams, internal subject matter experts, and client stakeholders to interpret CMS and state guidance and translate requirements into operational processes, system capabilities, and scalable solutions. Through research, analysis, testing, and validation, this role ensures that Exchange program operations achieve contractual, regulatory compliance, and business performance objectives.

Position Responsibilities:

Lead Government Programs support for Exchange operations, including claims adjudication, regulatory reporting, and audit support (Government and Client)

Oversee day-to-day operational performance for Exchange programs, ensuring alignment with contractual, regulatory requirements, and client expectations

Lead the interpretation, implementation, and monitoring of federal and state regulatory requirements impacting Exchange lines of business

Collaborate cross-functionally with SMEs (Claims, Product, Technology, Compliance, Legal) to assess regulatory impacts and ensure timely, coordinated implementation of required changes

Design, document, and scale operational processes that enable accurate, compliant, and efficient service delivery

Define business and system requirements to support compliant claims processing, data accuracy, and reporting outcomes

Lead regulatory reporting activities and ensure completeness, accuracy, and timeliness of all required submissions

Support internal and external audits by federal and state agencies, including audit preparation, documentation, issue response, and remediation tracking

Monitor Exchange program operations to identify and resolve issues, including root cause analysis and implementation of corrective actions

Partner with stakeholders to manage error handling, operational exceptions, and process improvements across claims and reporting functions

Identify opportunities to enhance operational performance, compliance, and scalability through process improvement and innovation

Own and maintain documentation of policies and procedures, reporting specifications, job aids, and workflows for Government Programs Operations

Maintain current knowledge of Exchange regulatory requirements and market trends to support compliance and strategic decision-making

Provide data-driven insights to improve operational effectiveness, reporting accuracy, and overall program performance

Foster a high-performance culture through mentoring, collaboration, and ongoing performance feedback

Assess impact of new business and regulatory changes to ensure appropriate scalability, resource planning, and organizational readiness

Required Qualifications:

6+ years of relevant Prescription Benefit Management and/or Health Plan experience supporting Exchange programs

5+ years people management experience

Subject matter expertise of Exchange regulatory requirements and associated product and/or operational workflows

Demonstrated experience supporting regulatory reporting, audits, and compliance activities

Extremely flexible, highly organized, and able to shift priorities easily

Attention to detail commitment to delivering high quality work product

Excellent written and verbal communication skills

Proven success managing cross functional teams and maintaining effective relationships at all levels both internal and external; including government entities

Strong operational mindset with experience improving processes and driving execution

Ability to translate regulatory guidance into business and system requirements

Extremely flexible, highly organized, and able to shift priorities in a fast-paced environment

Strong analytical skills and experience leveraging data to support decision-making

Attention to deta…