Own end-to-end delivery of PBM benefit data integration initiatives impacting claims, eligibility, accumulators, and related platforms.
Identify, assess, and manage program risks, including coordinating root-cause remediation efforts in partnership with engineering and operations teams.
Drive cross-functional alignment on technical and operational requirements to ensure scalable, compliant integration design.
Design and validate scalable solution architectures supporting claim processing, eligibility, accumulators, and reporting.
Partner cross-functionally with business stakeholders, internal development teams, and external vendors to improve systems, workflows, and data accuracy.
Own delivery timelines, milestone tracking, and executive-level reporting for benefit data integration initiatives.
Coordinate implementation readiness including rollback planning, validation artifacts, and post-deployment support models.
Ensure adherence to security standards, data governance practices, and operational policies.
Drive implementation validation including testing, rollback planning, data migration, and post-install support.

Bachelor’s degree in Statistics, Mathematics, Engineering, Computer Science, Business Analytics, or related quantitative field (required).
10+ years of progressive experience in healthcare analytics, PBM operations, data integration, or business systems analysis (required).
Experience within a PBM or healthcare claims processing environment (required).
Deep expertise in PBM benefit configuration, adjudication logic, eligibility, and accumulator integrations.
Advanced proficiency in SQL (advanced querying and data investigation)
Experience managing delivery timelines, risks, dependencies, and remediation coordination.
Working knowledge of ANSI/NCPDP Telecommunication Standard
Working understanding of PBM or TPA claim processing
Experience with data ETL processes and file delivery mechanisms (SFTP, PGP)
Experience with job scheduling automation and alerting tools
Microsoft Azure cloud experience, including blob storage
Familiarity with C#, Java, JavaScript, Python, or R preferred
Integration testing and UAT coordination experience

Principal TPM – PBM Benefit Data Integrations

Key skills