PBM Business Consultant

• 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.

• 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.

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, 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 View email address on us.fitly.work 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