Principal PBM Data Integration Lead

. Profile, map, and validate complex claims, eligibility, accumulator, and encounter data across multiple sources.

Posted 10/23/2026full-timeRemote • United StatesSenior💰 $148,000 - $205,000 per yearWebsite

Tools & technologies

AzureCloudETLJavaJavaScriptPythonSQL

Key responsibilities & impact

Profile, map, and validate complex claims, eligibility, accumulator, and encounter data across multiple sources.
Resolve daily eligibility and accumulator discrepancies arising from file imports and monthly reconciliations.
Write and execute advanced SQL for investigation, validation, regression testing, and special data loads.
Lead cross-functional root-cause investigation and remediation of production issues, and anticipate system and data failures.
Partner with engineering and architects on scalable, compliant integration architecture for claims, eligibility, and accumulators.
Own end-to-end delivery of benefit data integrations, including timelines, milestones, risks, dependencies, and executive reporting.
Coordinate with external vendors and internal engineering, translating vendor data formats and constraints.
Plan and coordinate integration testing, UAT, implementation readiness, data migration, rollback planning, and post-deployment support.
Communicate findings and recommendations to technical and non-technical stakeholders.
Maintain system documentation and operational procedures.

What you’ll need

Bachelor’s degree in Statistics, Mathematics, Engineering, Computer Science, Business Analytics, or a related quantitative field.
At least 10 years of hands-on technical experience with data systems, SQL, and integrations.
At least 6 years of direct PBM or pharmacy claims processing experience, including deep knowledge of benefit configuration, adjudication logic, eligibility, and accumulator integrations.
Advanced SQL proficiency, including complex querying and data investigation.
Experience supporting eligibility and accumulator reconciliation processes.
Experience designing scalable data architecture for healthcare data systems.
Experience managing delivery timelines, risks, and dependencies, and coordinating integration testing and UAT.
Working knowledge of the ANSI/NCPDP Telecommunication Standard and PBM or TPA claims processing.
Hands-on experience with ETL, secure file transfer (SFTP/PGP), and job scheduling and alerting tools.
Experience with a pharmacy benefits adjudication platform.
Cloud experience, ideally Microsoft Azure, in healthcare data environments.
Familiarity with C#, Java, JavaScript, Python, or R.

Comp & perks

The opportunity to grow alongside an early-stage company shaking up a big, old-fashioned industry.
Flexible time off, including 12 paid holidays.
401k match plus 100% employer-provided medical, dental, and vision premiums.
Company contribution to Health Savings Account.
Stock options.