PBM Business Consultant
Core
Translates moderately complex business needs into application software requirements and leads teams of analysts on complex projects within PBM operations.
Role type
Senior Business Consultant (Systems & Business Analysis)
Builds
Application software solutions for PBM operations, claims adjudication, and benefit configuration
Domain
Healthcare / Pharmacy Benefit Management (PBM)
Required skills
Business analysis, Project management, Systems analysis, Root cause analysis, Data analysis, Process improvement, Executive reporting, Risk assessment
Preferred skills
PBM operations knowledge, Pharmacy claims adjudication, Benefit configuration, Large dataset analysis, SQL/Databricks proficiency, Cross-functional leadership, Healthcare consulting experience
Technologies
SQL, Databricks, Excel
Responsibilities
Lead teams of analysts assigned to complex projects; Determine specific business application software requirements; Analyze and design solutions to address complex business needs; Consult with business partners on technology implementation; Lead restitution reviews and operational investigations; Conduct complex business and claims data analyses; Partner with cross-functional teams to evaluate risks and develop corrective actions; Facilitate root cause analysis efforts and drive process improvements; Develop impact assessment methodologies and executive-level reporting; Support strategic PBM Operations initiatives; Prepare and present findings to leadership; Maintain documentation and governance artifacts.
Seniority
Senior, hands-on IC with team leadership