Principal Pharmacy Operations Analyst

Blue Cross Blue Shield of Minnesota•Eagan, MN

10h•Hybrid

About The Position

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 Principal Operations Analyst. will focus on establishing and refining operational processes related to CMS, federal and state, ERISA, BCBSA requirements for Commercial, Medicare and Medicaid products. This position will develop an oversight structure of the departmental and key stakeholder activities. This oversight structure will include the establishment of KPI's and program dashboards to measure performance and implementation of programs.

Requirements

7+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
Professional experience in pharmacy at a health plan or PBM.
Project management/relationship management experience required, preferably in the pharmacy or healthcare industry preferred.
Strong data analysis and metrics/KPI development and monitoring.
Experience in triaging and resolving inquiries associated to claims and benefits.
Experience working Commercial, Medicare and/or Medicaid
High school diploma (or equivalency) and legal authorization to work in the U.S.

Nice To Haves

Previous experience in pharmacy technician role, with or without certification
PBM experience
Bachelor’s degree

Responsibilities

Provide operational oversight of pharmacy programs supporting Commercial, Medicare, and Medicaid products in alignment with CMS, federal and state regulations, and BCBSA requirements.
Establish, document, and maintain oversight processes, policies, and internal controls for delegated pharmacy functions to proactively identify and mitigate operational and compliance risk.
Develop, manage, and present pharmacy performance dashboards and KPIs, including claims, coverage decisions and appeals, formulary, networks, volume trending, quality outcomes, and performance guarantees.
Partner with Compliance Officers and senior leadership to communicate operational performance, risks, and improvement opportunities through reporting and analytics.
Lead cross-functional initiatives to enhance pharmacy processes and technology capabilities, partnering with IT, Pharmacy, Operations, Compliance, Audit, and Customer Experience/Service teams.
Develop and manage project plans, timelines, stakeholders, and external vendor initiatives to ensure accurate, timely, and coordinated implementation of pharmacy programs and regulatory requirements.
Oversee PBM and Pharmacy Analysts operational work across Commercial, Medicare, and Medicaid programs, ensuring quality, accuracy, and regulatory compliance.
Manage operational requirements related to payment integrity, benefit configuration, data analysis, PDE/Encounter submissions, regulatory implementation, audit management, and regulatory reporting.
Serve as a primary operational contact for regulatory and external entities including CMS, MN DHS, DOC, MDH, BCBSA, and ERISA-related requests.
Oversee intake, investigation, and resolution of pharmacy-related inquiries from members, regulators, and internal partners.
Monitor and manage vendor service level agreements and performance guarantees.
Draft, maintain, and update administrative pharmacy policies aligned to operational responsibilities.