Data Architect – PBM Data Modernization
Role Overview We are looking for a Data Architect to lead data modeling and source-to-target mapping for a Pharmacy Benefit Manager (PBM) modernization program on Google Cloud. The role covers migrating legacy claims and eligibility data, and the IBM Cognos reporting built on it, into a new BigQuery-based enterprise data warehouse. It also ensures the future-state platform meets state-specific Medicaid reporting requirements, starting with the MVP.
Key Responsibilities
- Define the semantic and logical data models for MVP and future-state reporting, covering pharmacy claims, member eligibility, prescriber, pharmacy network, formulary, rebates, and pricing domains.
- Own mapping execution end to end. Define source-to-target mappings, transformation rules, and business logic from legacy structures to the new warehouse.
- Inventory and analyze legacy IBM Cognos (Cognos Explorer / Cognos Analytics) reports, packages, and Framework Manager models. Reverse-engineer embedded business logic and calculations, and rationalize reports for redesign on the future-state platform.
- Set mapping standards, templates, naming conventions, and documentation practices. Direct the Data and Systems Analysts and review their work for quality and consistency.
- Lead gap analysis and drive each gap to a decision (build, defer, workaround, or descope) with business, compliance, and technical stakeholders.
- Translate state Medicaid reporting requirements (encounter data submissions, MCO/PBM transparency reports, spread pricing and pass-through disclosures, T-MSIS-aligned extracts) into data model and mapping specifications.
- Define data quality rules, reconciliation checkpoints, and lineage so legacy-to-target results, including Cognos report outputs, are traceable and audit-ready.
- Work with data engineers on ingestion and transformation design on Google Cloud Platform, and use Vertex AI and Gemini to speed up mapping, profiling, and documentation.
Qualifications
- 10+ years in data architecture or data modeling, with at least 3 years in PBM, pharmacy, or health plan data.
- Hands-on experience with NCPDP claim standards, Medicaid and managed care reporting, and legacy migration programs.
- Strong skills in dimensional and semantic modeling, plus advanced SQL.
- Experience with IBM Cognos Analytics / Cognos Explorer, including Framework Manager packages, report specifications, and migrating Cognos reporting to a modern BI platform.
- Hands-on experience with Google Cloud data services:
– BigQuery for warehouse design, including partitioning, clustering, and authorized views – Dataflow and Dataproc for transformation pipelines – Cloud Composer (Airflow) for orchestration – Cloud Storage for landing zones – Dataform or dbt for SQL-based transformations
- Familiarity with Dataplex and Data Catalog for metadata, lineage, and data quality, and with Looker (LookML) for building the semantic layer.
- Proven experience leading analyst teams and running mapping governance.
- Working knowledge of HIPAA, CMS regulations, and state-level Medicaid compliance, along with Google Cloud Platform security controls (IAM, VPC Service Controls, CMEK).
Nice to Have
- Exposure to Vertex AI or Gemini in BigQuery for AI-assisted mapping, profiling, and documentation.
- Google Cloud Professional Data Engineer or Professional Cloud Architect certification.