PBM Business Consultant

Elevance Health; Cincinnati (OH); Hybrid; USD 88,000 - 145,000; Full time

Benefits offered by this job

Hybrid work

Comprehensive benefits

Equity stock purchase

Job summary

Elevance Health seeks a PBM Business Consultant to translate complex business needs into software requirements. You will oversee analysts, specify software requirements, and design solutions in collaboration with cross-functional teams, ensuring alignment with PBM operations and regulatory needs.

The role emphasizes data analysis, operational risk assessment, and executive-level reporting, with a hybrid in-office schedule and a strong focus on compliance and governance artifacts.

Qualifications

• BA/BS and minimum of 8 years business analysis experience.
• Experience with analysis and project management.
• Strong analytical and problem-solving skills with large datasets.
• Ability to translate complex findings into actionable recommendations.

Responsibilities

• Lead teams of analysts on complex projects.
• Determine specific business software requirements to address complex needs.
• Analyze and design solutions to address complex business needs.
• Consult with business partners concerning application and technology implementations.
• Prepare findings, recommendations, and status updates to leadership.

Skills

Business analysis

Project management

Stakeholder communication

Data interpretation

Executive reporting

Education

BA/BS degree

Tools

Excel

SQL

Python

Job description

PBM Business Consultant

Hybrid 1: This role requires associates to be in-office1 - 2days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace.

Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.

The PBM Business Consultant responsible for translating moderately complex and varied business needs into application software requirements. Possesses full technical knowledge of most phases of systems and business analysis and is able to consider the business implications of the application of technology to current and future business environments.

How you will make an impact

Primary duties may include, but are not limited to:

• May lead teams of analysts assigned to complex projects.
• Determines specific business application software requirements to address complex and varied business needs.
• Analyzes and designs solutions to address complex and varied business needs.
• Consults with business partners concerning application and implementation of technology.
• Lead restitution reviews and operational investigations to assess member, client, and financial impacts resulting from process, system, or configuration issues.
• Conduct complex business and claims data analyses to quantify impact, identify trends, and support remediation recommendations.
• Partner with cross-functional teams including Operations, Product, Technology, Finance, Compliance, and Client Services to evaluate risks and develop corrective actions.
• Facilitate root cause analysis efforts and drive process improvements that strengthen operational controls and prevent future issues.
• Develop impact assessment methodologies, business cases, and executive-level reporting to support decision making.
• Support strategic PBM Operations initiatives by evaluating operational impacts, implementation risks, and business performance outcomes.
• Prepare and present findings, recommendations, and status updates to leadership and key stakeholders.
• Maintain documentation and governance artifacts to support compliance, audit, and contractual obligations.
• Think end to end and take accountability for your work

Minimum Requirements

Requires a BA/BS and minimum of 8 years business analysis experience, which should include analysis and project management; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences

• Knowledge of systems capabilities and business operations is strongly preferred.
• Knowledge of PBM operations, pharmacy claims adjudication, and benefit configuration is preferred
• Experience with impact analysis, operational risk assessments, and root cause investigations is preferred
• Strong analytical and problem-solving skills with experience working with large datasets is preferred
• Proficiency in Excel, SQL, Python, or similar reporting and analytics tools is preferred
• Ability to translate complex findings into actionable business recommendations is preferred
• Strong communication and presentation skills, including executive-level reporting is preferred
• Experience leading cross-functional initiatives and driving process improvements is preferred
• Healthcare, PBM, compliance, or operational consulting experience preferred.

For candidates working in person or virtually in the below locations, the salary* range for this specific position is $87,680 to $144,672

Locations: Connecticut, Virginia, Massachusetts, Illinois

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state, and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the Accessibility Accommodation Request Form and a member of the team will be in contact.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.