PBM Business Consultant

Anticipated End Date:

2026-10-31

Position Title:

PBM Business Consultant

Job Description:

PBM Business Consultant

Hybrid 1: 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.

The PBM Business Consultant responsible for translating moderately complex and varied business needs into application software requirements. Possesses full technical knowledge of most phases of systems and business analysis and is able to consider the business implications of the application of technology to current and future business environments.

How you will make an impact

Primary duties may include, but are not limited to:

• •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.

Minimum Requirements:

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.

Preferred Skills, Capabilities and Experiences:

• •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.

For candidates working in person or virtually in the below locations, the salary* range for this specific position is $87,680 to $131,520

Location: Virginia

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 this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

Job Level:

Non-Management Exempt

Workshift:

1st Shift (United States of America)

Job Family:

• BSP > Business Support
• Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and 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, sexua