Senior Advisor – Rx Claims & Adjudication; Business Architect

Senior Advisor – Rx Claims & Adjudication (Business Architect)

The position requires association with an in‑office presence 1‑2 days per week in the Minnesota region, with hybrid work arrangements considered for candidates within a reasonable commuting distance.

• Serve as the enterprise subject‑matter expert on pharmacy claims adjudication, benefit design, and pricing logic.
• Interpret complex adjudication outcomes and translate insights into clear business decisions.
• Identify adjudication defects, inconsistencies, and financial leakage risks.
• Support resolution of high‑impact claims issues and escalations.
• Advise on claims platform configuration, including rules, pricing logic, and edits.
• Represent the organization in client discussions, audits, and SME panels.
• Collaborate with other Enterprise Architecture groups and models to coordinate activities toward future‑state capabilities.
• Contribute to reference architectures, Strategic Business Architecture (SBA), and Operational Business Architecture (OBA) that optimize the value chain.
• Drive the Business Architecture portion of business blueprints: establish guiding principles, define capabilities, perform functional analysis, document the value chain, and assess organizational impacts.
• Propose enterprise‑wide functional analyses to identify efficiencies or rationalization opportunities.
• Conduct ongoing analysis of business capabilities and recommend architecture component improvements.
• Execute standardized processes for assessing projects against business architecture artifacts and blueprints, integrating them into overall architecture governance.
• Communicate and build consensus with business executives, technologists, end users, and operations.

Minimum requirements:

BA/BS degree in Information Technology, Computer Science, or a related field, and a minimum of 5 years of experience in business analysis, strategic planning, IT operations, IT leadership, and technical architecture, with at least 3 years in organizational management related to information architecture; or an equivalent combination of education and experience.

• Deep claims adjudication expertise.
• Proficiency with pricing methodologies such as AWP, MAC, GER, and rebates.
• Knowledge of NCPDP standards and claim transaction formats.
• Understanding of PBM operations, payer workflows, and claims adjudication platforms.
• Strategic advisory capability.
• Strong presentation skills for leadership and external stakeholders.
• Ability to bridge business and technical discussions effectively.

Location:

Minnesota (hybrid work model). Salary range: $126,720 to $190,080. Benefits include a comprehensive package with incentive and recognition programs, equity stock purchase, and 401(k) contribution.

Elevance Health is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, gender expression, marital or civil partnership status, sexual orientation, national origin, disability, protected Veteran status, age, genetic information, or any other status protected by applicable federal, state, or local laws.