Hybrid: SQL Analyst with PBM

Job Description We are seeking experienced SQL engineer with strong PBM (Pharmacy Benefit Management) Eligibility domain knowledge. The role requires hands-on expertise in SQL query development, data validation, and issue analysis. The candidate will be responsible for manually validating eligibility files prior to ingestion and collaborating closely with the Customer EDI Team to analyze and report data issues.

Key Responsibilities - Develop, optimize, and execute complex SQL queries to validate eligibility and related PBM data - Perform manual validation of eligibility files before they are loaded into downstream systems - Analyze data discrepancies, eligibility errors, and file-related issues - Document findings clearly and report issues to the Customer EDI Team in a timely manner - Support root cause analysis for eligibility failures or mismatches - Ensure data accuracy, completeness, and compliance with PBM eligibility requirements - Work closely with EDI, operations, and technical teams to resolve data issues

Qualifications Required Skills and Qualifications - Strong hands-on experience with SQL (complex joins, subqueries, aggregations, validations) - Proven experience in PBM Eligibility processing and validation - Solid understanding of eligibility file formats and data flows in PBM environments - Experience performing manual data validation and reconciliation - Strong analytical and problem-solving skills - Ability to clearly communicate issues and findings to technical and business teams Preferred Qualifications - Prior experience working with EDI teams, especially PBM-related EDI processes - Familiarity with eligibility file standards (e.g., 834 or PBM-specific formats) - Experience supporting healthcare or pharmacy benefit systems - Attention to detail and ability to work with large datasets Soft Skills - Strong communication and documentation skills - Ability to work independently and manage priorities - Collaborative mindset when working with cross-functional teams