Sr Test Analyst PBM

Elevance Health (Anthem); Indianapolis (IN); Hybrid; USD 90,000 - 120,000; Full time

Job summary

Elevance Health is seeking a Sr Test Analyst PBM to translate complex business needs into pharmacy benefits software. You will ensure accurate setup of formulary and utilization management components and validate configurations using claims testing.

Role requires BA/BS and 5+ years in business analysis, with strong pharmacy benefit knowledge and healthcare domain experience. Hybrid in-office 1–2 days weekly; government division rules may apply.

Qualifications

• Requires a BA/BS and minimum of 5 years business analysis experience, or equivalent background.
• If assigned to Government Business Division, additional background checks and sensitive data handling requirements apply.
• Preferred: 4+ years of US healthcare domain experience in Commercial/Medicaid/Medicare and pharmacy benefit processing.

Responsibilities

• Ensure accurate setup and validation of pharmacy benefits systems including formulary and utilization management components.
• Validate pharmacy benefit setup and configurations using Claims/Query testing for formulary and utilization management.
• Coordinate with business and adjudication teams to triage and resolve defects efficiently.
• Collaborate with globally dispersed cross-functional teams to ensure successful coordination.
• Analyze end-user needs to determine optimal ways to meet those needs.
• Define software requirements and develop plans, coordinating resources across units.
• Work with developers to ensure requirements are reflected in system design and testing.
• Serve as a resource to users to address questions/issues and provide guidance.

Skills

Business analysis

Pharmacy benefit

Healthcare domain

Data analysis

Communication

Agile

Education

BA/BS

Tools

Jira

Confluence

MS Excel

VB Macro/C#

Job description

Anticipated End Date: 2026-09-25

Position Title: Sr Test Analyst PBM

Job Description: Sr Test Analyst PBM

Hybrid: This role requires associates to be in-office 1-2 days 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 an accommodation is granted as required by law.

CarelonRx is a proud member of the Elevance Health family of companies. CarelonRx pairs a strong, clinical-first lens with deep pharmacy expertise to create solutions that improve outcomes, control costs, and enhance each member's health.

The Senior Test Analyst PBM is responsible for serving as the liaison between the business and IT in translating complex business needs into application software. Ensures the accurate setup and validation of pharmacy benefits systems, including formulary and utilization management components.

How you will make an impact:

• Ensure the accurate setup and validation of pharmacy benefits systems, including formulary and utilization management components.


• Understand the Pharmacy benefit setup & validate the configuration to ensure the accurate setup using Claims/Query testing.


• Validation of Formulary, Utilization Management & Drug List setup using Claims/Query testing.


• Identify, triage, and collaborate with business and adjudication teams to resolve defects efficiently and effectively.


• Work closely with globally dispersed cross-functional teams to ensure successful coordination and collaboration.


• Analyzes complex end user needs to determine optimal means of meeting those needs.


• Determines specific business application software requirements to address complex business needs.


• Develops project plans and identifies and coordinates resources, involving those outside the unit.


• Works with programming staff to ensure requirements will be incorporated into system design and testing.


• Acts as a resource to users of the software to address questions/issues.


• May provide direction and guidance to team members and serves as an expert for the team.

Minimum Requirements:

Requires a BA/BS and minimum of 5 years business analysis experience; or any combination of education and experience which would provide an equivalent background.

If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a 'sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.

Preferred Skills, Capabilities, and Experiences:

• Pharmacy Benefit experience & Clinical knowledge.


• 4+ years of experience in the US Healthcare domain (Commercial/Medicaid/Medicare) supporting pharmacy including claims processing and benefit administration.


• Significant experience working in the Medicaid line of business is highly desired, with additional experience in Commercial or Medicare being a plus.


• Proficiency in Data Analysis.


• Strong communication, problem-solving, facilitation, and analytical skills.


• Experience preparing and presenting testing status and metrics reports to stakeholders.


• Experience collaborating within matrix team; familiarity with Agile methodologies.


• Experience with test automation tools and test data management.


• Experience with Jira, Confluence, Expertise in MS Excel.


• Automation skills (VB Macro/C#).


• Knowledge of systems capabilities and business operations.

Job Level:

Non-Management Exempt

Workshift:

1st Shift (United States of America)

Job Family:

BSP > Business Support

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a c