PBM Business Consultant

Elevance Health

. Translate moderately complex and varied business needs into application software requirements.

Posted 10/9/2026full-timeUnited StatesSeniorLead💰 $87,680 - $131,520 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in business analysis, project management, and operational risk assessment, with a strong focus on translating complex data into actionable business recommendations. Proficient in leading cross-functional teams and facilitating process improvements within the healthcare and PBM sectors.

Highest-signal resume keywords

Business AnalysisProject ManagementOperational Risk AssessmentData AnalysisHealthcare Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Impact AnalysisRoot Cause InvestigationPharmacy Claims AdjudicationBenefit ConfigurationLarge Dataset Analysis

Soft Skills

Analytical SkillsProblem-Solving SkillsCommunication SkillsPresentation Skills

Tools & Technologies

ExcelSQLDatabricks

Industry Keywords

PBM OperationsOperational ConsultingComplianceBusiness Operations

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

Translate moderately complex and varied business needs into application software requirements.
Lead teams of analysts assigned to complex projects.
Determine specific business application software requirements for complex and varied business needs.
Analyze and design solutions to address complex and varied business needs.
Consult 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 Operations, Product, Technology, Finance, Compliance, and Client Services to evaluate risks and develop corrective actions.
Facilitate root cause analysis and drive process improvements that strengthen operational controls and prevent future issues.
Develop impact assessment methodologies, business cases, and executive-level reporting.
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 for compliance, audit, and contractual obligations.

Requirements

What you’ll need

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, Databricks, 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.

Benefits

Comp & perks

comprehensive benefits package
incentive and recognition programs
equity stock purchase
401k contribution
merit increases
paid holidays
Paid Time Off
incentive bonus programs
medical benefits
dental benefits
vision benefits
short and long term disability benefits
401(k) +match
stock purchase plan
life insurance
wellness programs
financial education resources