Principal Business Analyst - Utilization Management

About Blue Cross

Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us.

Blue Cross Blue Shield of MN is hiring a Principal Business Analyst to support our Utilization Management (UM) team in Eagan, MN. The Principal Business Analyst will support the UM Team with NCQA accreditation requirements, regulatory compliance, and acting as a liaison for provider requests. Responsibilities include conducting root cause analysis, handling member and provider escalations, and ensuring accurate DHS reporting. The specialist also stays informed about industry changes and assists with initiative implementation. Additionally, they provide guidance for UM-related tasks and assess regulatory impacts on communication materials.

This person must be able to perform highly complex work under limited supervision in support of developing and implementing strategic business solutions through research, audit, and analysis of data. This position functions as a Content Expert/Business Lead on various projects and work assignments.

A Day in the Life:

• Directs and coordinates individual projects and related activities to ensure project progresses on schedule.

• Maintains adequate communication regarding project status, risks, issues, and priorities with project sponsors and leadership.

• Conducts in-depth research and analysis.

• Anticipate trends, emerging issues and recommend best practices to ensure maximum results and develops metrics.

• Develops integrated solutions to unique and highly complex problems.

• Recommends best practices to ensure maximum performance and develops performance measures.

• Documents performance measurements and process changes.

• Responsible for overseeing the process of representing the customer and/or stakeholder (internal/external) while collaborating with business and technical units.

• Acts as a liaison with internal partners and external partners to identify opportunities and needs and researches/develops implementation plans for meeting these needs.

• Expert working knowledge of analysis, design, development, testing, debugging, implementation, maintenance and/or enhancement of new or existing systems through reporting and documentation.

• Recognized expert within the function, the division, and the organization.

• Facilitates project teams and may provide training to lower level staff to achieve milestones and objectives.

• Maintains adequate communication regarding project process.

• Maintains adequate communication regarding project status, risks, issues, and priorities with project sponsors and leadership.

Nice To Have:

• Bachelor's degree.

• Utilization Management experience strongly preferred.

• Experience with NCQA accreditation.

Required Skills and Experiences:

• 7+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.

• Expert collaborative, interpersonal, verbal and written communication skills and demonstrated ability to develop accurate and appropriate communications to all levels of management.

• Strong experience with the MS Office suite.

• Exceptional research, analytical and problem solving skills.

• Expert level ability to make decisions based on analysis and business needs.

• Exceptional ability to work in high paced environment, handling multiple responsibilities and projects.

• Expert ability to build cross functional relationships, which includes negotiation and persuasion skills.

• Expert analytical, conceptual, and logic skills to take high-level business product concepts and translate to operational level business models.

Role Designation:

Hybrid Remote

Role designation definition: Teleworking is working full time remote. Hybrid is a combination of working onsite and remotely. Onsite is full-time onsite.

Make a difference

Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.

Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.

All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.

Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association.