Senior Business Analyst - Utilization Management

Responsibilities

• Conducts in-depth research and analysis.
• Identifies trends, emerging issues and recommends best practices to ensure maximum results and develops metrics.
• Documents metrics and process changes.
• Effectively analyzes, designs, develops, tests, debugs, implements, maintains and/or enhances new or existing systems through reporting and documentation.
• Participate in and coordinate 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.
• Acts as a liaison with internal partners and external partners to identify opportunities and needs and researches/develops implementation plans for meeting these needs.
• Responsible for representing the customer and/or stakeholder (internal/external) while collaborating with business and technical units.
• Serves as senior subject matter expert associated with content, processes, and procedures.
• May lead project teams and may provide training to lower level staff to achieve project milestones and objectives.
• Required Skills and Experience
• 5+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• Advanced collaborative, interpersonal, oral and written communication skills and demonstrated ability to develop accurate and appropriate communications.
• Advanced ability to communicate to all levels of management.
• Advanced research, analytical and problem solving skills.
• Advanced skills in Microsoft Excel, Word, and Access.
• Strong ability to make decisions based on analysis and business needs.
• Advanced ability to bring a different perspective to situations and challenge the status quo.
• Project management skills.
• Proven ability to work independently with guidance in only the most complex situations.
• High school diploma (or equivalency) and legal authorization to work in the U.S.
• Preferred Skills and Experience
• Bachelor's degree in Healthcare, Nursing, Health Informatics, Business, or a related field (or equivalent experience)
• Clinical background (e.g., RN, LPN, MD, PharmD) or significant clinical workflow experience
• Strong hands-on experience with UM automation tools
• Proven experience with Utilization Management and Prior Authorization workflows
• Demonstrated experience designing or supporting clinical decision support or automation solutions
• Experience working in Agile, hybrid, or waterfall delivery environments
• Experience integrating PA systems with EDI, APIs, or provider portals
• Experience using Jira
• Role Designation
• Hybrid
• Anchored in Connection
• Compensation and Benefits
• $90,800.00 - $120,300.00 - $149,800.00 Annual
• Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.
• We offer a comprehensive benefits package which may include:
• Medical, dental, and vision insurance
• Life insurance
• 401k
• Paid Time Off (PTO)
• Volunteer Paid Time Off (VPTO)
• And more
• To discover more about what we have to offer, please review our benefits page .
• Equal Employment Opportunity Statement
• At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affir

Benefits

Additional Information

About Blue Cross and Blue Shield of Minnesota At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us. The Impact You Will Have The Utilization Management Business Analyst is responsible for leading the design, documentation, configuration, testing, training, and ongoing support of prior authorization (PA) automation solutions and Utilization Management (UM) platforms. This role serves as a key liaison between clinical, operational, and technical stakeholders to ensure automated PA workflows align with evidence-based guidelines, regulatory requirements, and business objectives. The ideal candidate brings deep expertise in clinical utilization management, payer operations, and healthcare IT systems, with a proven ability to translate complex clinical and regulatory requirements into scalable, automated solutions.

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