Principal PBM Data Integration Lead

This is a fully remote position, open to applicants in Alabama, +45 more states.

📋 Description

• Profile, map, and validate intricate claims, eligibility, accumulator, and encounter data from various sources.

• Address daily discrepancies in eligibility and accumulators that arise from file imports and monthly reconciliations.

• Develop and execute advanced SQL queries for investigation, validation, regression testing, and specialized data loads.

• Lead cross-functional investigations to identify root causes and resolve production issues, while anticipating potential system and data failures.

• Collaborate with engineering teams and architects to create scalable and compliant integration architectures for claims, eligibility, and accumulators.

• Take ownership of the complete delivery process for benefit data integrations, managing timelines, milestones, risks, dependencies, and executive reporting.

• Work with external vendors and internal engineering teams to translate vendor data formats and constraints effectively.

• Plan and oversee integration testing, user acceptance testing (UAT), implementation readiness, data migration, rollback planning, and post-deployment support.

• Share findings and recommendations with both technical and non-technical stakeholders.

• Maintain comprehensive system documentation and operational procedures.

⛳️ Requirements

• Bachelor’s degree in Statistics, Mathematics, Engineering, Computer Science, Business Analytics, or a related quantitative discipline.

• A minimum of 10 years of practical technical experience with data systems, SQL, and integrations.

• At least 6 years of direct experience in pharmacy benefit management (PBM) or pharmacy claims processing, including in-depth knowledge of benefit configuration, adjudication logic, eligibility, and accumulator integrations.

• Advanced proficiency in SQL, including complex querying and data analysis.

• Background in supporting eligibility and accumulator reconciliation processes.

• Experience in designing scalable data architectures for healthcare data systems.

• Proven ability to manage delivery timelines, risks, and dependencies while coordinating integration testing and UAT.

• Familiarity with the ANSI/NCPDP Telecommunication Standard as well as PBM or third-party administrator (TPA) claims processing.

• Practical experience with ETL processes, secure file transfer (SFTP/PGP), and job scheduling and alerting tools.

• Experience with a pharmacy benefits adjudication platform.

• Cloud experience, preferably with Microsoft Azure, in healthcare data environments.

• Knowledge of programming languages such as C#, Java, JavaScript, Python, or R.

🏝️ Benefits

• An opportunity to grow with an early-stage company that is transforming a traditional industry.

• Flexible time off policy, including 12 paid holidays.

• 401k matching plus 100% employer-funded medical, dental, and vision premiums.

• Company contributions to Health Savings Accounts.

• Stock options provided.