- Company: Elevance Health
- Location: Capitol, Richmond
- Full Time
- Capitol, Richmond
- Apply on company site
Elevance Health at a glance
elevancehealth.com- Founded 2004
- Ticker ELV
- Revenue (FY2025) $199.12B
- Net income $5.66B
Investor research: Yahoo Finance · SEC filings
Source: Wikipedia
Join Elevance Health as a Senior Advisor – Rx Claims & Adjudication (Business Architect) in Capitol, Richmond. This full-time position offers the strategic opportunity to shape pharmacy claims processing and adjudication workflows while maintaining work-life balance with flexible scheduling and 1–2 days per week of in-office collaboration.
About the Role
As a Senior Advisor focused on Rx Claims & Adjudication, you will drive business transformation across our pharmacy benefits operations. Your expertise in claims processing, adjudication logic, and architectural design will inform systems improvements, process optimization, and strategic initiatives that serve millions of pharmacy transactions annually. You'll partner with clinical, technology, and operations teams to translate business requirements into actionable solutions.
What You'll Do
- Lead the design and optimization of pharmacy claims adjudication workflows, including coverage rules, benefit coordination, and exception handling
- Analyze current state operations and identify opportunities for efficiency, accuracy, and member/provider satisfaction
- Develop business requirements and technical specifications for system enhancements and architectural improvements
- Collaborate cross-functionally with clinical, compliance, IT, and operations stakeholders to validate solutions
- Support policy and compliance initiatives related to pharmacy claims processing and regulatory requirements
- Mentor team members and contribute to continuous improvement of business practices
What We're Looking For
- 7+ years of experience in pharmacy benefits, claims processing, adjudication, or related healthcare operations
- Demonstrated expertise in business architecture, process design, or claims system administration
- Strong understanding of pharmacy benefit plan design, pharmacy networks, and drug coverage rules
- Excellent analytical, problem-solving, and communication skills
- Proven ability to influence stakeholders and drive initiatives across organizational boundaries
- Bachelor's degree in healthcare, business, or related field (or equivalent professional experience)
- Note: This position is not eligible for visa sponsorship
About Elevance Health
Elevance Health is a leading health benefits company committed to improving lives and communities through equitable, affordable, and accessible healthcare solutions. We empower millions of members to live healthier lives while supporting providers and employers in delivering quality care.
How to Apply
To apply, complete your application directly on this page, or you'll be redirected to the employer's application platform to finish submitting there.
To apply for this job please visit www.adzuna.com.
Explore Elevance Health online
What people say about Elevance Health
- Anthem Is Cutting Access to Out-of-Network Doctors
- Food, housing, & health care costs are a source of major stress for many people
- Anthem drops controversial new plan to cap anesthesia coverage after backlash
- US prosecutors recommend Justice Department criminally charge Boeing
Recent news
- Chutes & Ladders— ANA taps new president; OU Health announces new CEO - Fierce Healthcare
- Analysts Estimate Elevance Health (ELV) to Report a Decline in Earnings: What to Look Out for - Yahoo Finance
- Elevance sues CMS over $115M Medicare Advantage star ratings dispute - Healthcare Finance News
- Elevance Health sues CMS in latest challenge to Medicare Advantage star rating methodology - HealthExec
- Elevance Health options suggest 5.6% move on July 15 earnings - Investing.com
Aggregated from public discussions and news; opinions are the authors’ own.
Working in Capitol, Richmond
Weather right now in Capitol, Richmond: checking… · Local time: · Air quality: · Daylight: · UV index: · Wind:
Virginia, officially the Commonwealth of Virginia, is a state in the Southeastern and Mid-Atlantic regions of the United States between the Atlantic Coast and the Appalachian Mountains. It borders Kentucky to the west, Tennessee to the south-west, North Carolina to the south, West Virginia to the north-west, and Maryland to the north. The state's capital is Richmond and its most populous city is V
🇨🇦 Relocation safety for Canada: Very Safe — via Warnely, CC BY 4.0
National unemployment rate in Canada: 6.9% — via World Bank
GDP per capita in Canada: $55,698 — via World Bank
Consumer price inflation in Canada: 2.1% (annual) — via World Bank
Nearby history: Virginia Washington Monument, listed 2004 (75m away) — via National Register of Historic Places
Typical climate: average high 70°F / low 48°F year-round (summers around 88°F, winters around 30°F) — via NOAA 1991-2020 Normals
- Elevation 54m (177 ft)
Source: Wikipedia (state)
Job details above are provided by the employer/source. The sections on this page are compiled from public data sources with AI assistance.
Accommodations: if you need a workplace accommodation to apply for or perform this job, see ADA.gov or EEOC.gov for guidance on your rights and how to request one.
Keep exploring on Get A Job.ai
Not quite the right fit? Your next opportunity is a click away.
- Browse all jobs
- More jobs by category
- Remote jobs you can do from anywhere
- Research typical pay for this role
- Set a job alert so new matches reach you first
- Upload your resume to apply faster
Hiring instead? Post a job and reach candidates searching right now.