PBM Business Consultant

PBM Business Consultant

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 accommodation is granted as required by law.

• 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.

• 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.

• 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.

• Connecticut
• Virginia
• Massachusetts
• Illinois

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

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).

The salary offered for…