Jess Favorite Email & Phone Number

• Provide configuration services and support of Capital Rx’s Software as a Service (SaaS) customers for migration and ongoing use of JUDI.• Provide customers with subject matter expertise in JUDI’s capabilities, ensuring successful migration to the adjudication platform, with parity of all plan benefit logic and initiatives.• Accountable for accurate translation of requirements/setup of plan benefits from previous adjudication systems and configure to the customer’s intent.• Build and maintain trusting relationships with customers through superior customer service, meeting or exceeded service level metrics.• Lead communications throughout the implementation period by providing detailed and strategic guidance on plan benefit configuration, including intersection points with network, formulary, clinical and data exchanges.• Proactively identify execution risks that would inhibit successful launch in JUDI or negatively impact member experience and propose mitigation strategies.• Identify and make recommendations drive configuration efficiencies for SaaS customers in JUDI.Conduct comprehensive testing and review of plan benefit configurations using JUDIs Testing Module.• Monitor live claims for accuracy.• Responsible for ongoing customer support for set up for configuration evaluations and troubleshooting inquiries, working directly with customers, vendors, and operations teams to achieve positive outcomes, within the required turnaround times to meet service level agreements.

• Project management for complex and extensive specialty pharmacy projects related to new and improved pharmacy and PBM products, regulatory compliance, financial aid programs. • Develop and implement strategic programs to optimize specialty pharmacy benefits and processes for improved patient outcomes and cost savings, increasing cost-saving programs for members, program value for clients. • Lead efforts to identify initiatives to increase specialty pharmacy script capture rate for all specialty therapeutic classes, increasing pharmacy program cost effectiveness and member experience in the high-cost drug space. • Track federal and state regulatory changes to ensure compliance within client benefit restrictions and pharmacy/PBM practices. • Resolve complex member claim inquiries and group benefit implementation issues including reviews for complaints filed with the Department of Insurance and via VIP submissions from client liaisons and account managers. • Lead educational training sessions on innovative programs/products and knowledge transferring discussions regularly to new and seasoned employees to improve understanding of how each program impacts member and client experiences.

• Collaborated with Account Management to implement plan structure for pharmacy benefit plans within RxCLAIM/AS400 and other various IT platforms across the business. As a Lead configuration analyst this included complex and custom clients with large numbers of lives attached to their plan. • Performed an array of claim testing to ensure proper claim adjudication and benefit setups for clients. Created testing models to streamline thorough testing. • Worked on an Internal Quality Review team and led coaching sessions to assist with complicated benefit builds. • Participated in project management forums as Benefits Operations Management SME to code new products and programs for clients to meet customization requests or regulatory requirements. • Heavy focus on attention to detail and time management, meeting deadlines while maintaining high quality especially during benefit implementation peak season. Constructed and upkept an automated benefit configuration tool to help department drive quality and throughput for all simple benefit requests and much of the customization requested by clients.