Senior Advisor – Rx Claims & Adjudication; Business Architect

Senior Advisor – Rx Claims & Adjudication ( Business Architect)

Please note:

This position is not eligible for current or future visa sponsorship.

Location :
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.

Positive qualified candidates must reside within a reasonable commuting distance from the posting location(s) unless an accommodation is granted as required by law.

• Serve as the enterprise Subject Matter Expert (SME) on pharmacy claims adjudication, benefit design, and pricing logic.
• Interpret complex adjudication outcomes and translate 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 (e.g., rules, pricing logic, edits).
• Represent the organization in client discussions, audits, and SME panels.
• Participate in providing linkage to other Enterprise Architecture groups and models, and coordinate and align activities to achieve the future state capabilities in partnership with Business Relationship Management (BRM).
• Contribute to Reference architectures, Strategic Business Architecture (SBA) and Operational Business Architecture (OBA) that articulate a future state direction to optimize the value chain.
• Contribute to the Business Architecture portion of business blueprints, including establishing guiding principles, defining capabilities, performing functional analysis, documenting the value chain, and assessing organizational impacts.
• Propose ideas for performing enterprise‑wide functional analysis to identify areas for efficiencies or rationalization opportunities, and conduct ongoing analysis of business capabilities and how improvements to architecture components can best support capabilities.
• Execute a common process for how projects are assessed against business architecture artifacts and blueprints; incorporate into overall architecture governance process.
• Communicate and build consensus effectively with business executives, technologists, end users, and operations.

Requires a BA/BS degree in Information Technology, Computer Science, or related field and a minimum of 5 years of experience in business analysis and strategic planning, IT operations, IT leadership strategic 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, pricing methodologies (AWP, MAC, GER, rebates), NCPDP standards and claim transactions.
• Understanding of PBM operations, payer workflows, and claims adjudication platforms.
• Strategic advisory capability. Present confidently to leadership and external stakeholders.
• Ability to bridge business and technical discussions effectively.

The salary range for this position is $126,720 to $190,080.

Location(s):
Minnesota

Elevance Health is an Equal Employment Opportunity employer; 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 may contact elevancehealthj for assistance.

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.