Senior Business Analyst - Utilization Management/Behavioral Health

Blue Cross Blue Shield of Minnesota•Eagan, MN

7d•Hybrid

About The Position

Blue Cross and Blue Shield of Minnesota is seeking a Senior Business Analyst to join our Utilization Management (UM) Product team, with a focus on Behavioral Health (BH). In this highly visible role, you will serve as the Behavioral Health subject matter expert, helping shape strategy and drive initiatives that improve affordability, quality, and member outcomes. Working closely with product leaders, clinical partners, and business stakeholders, you will translate complex behavioral health clinical and operational insights into actionable business requirements, impact analyses, and implementation plans that support enterprise priorities. The ideal candidate brings strong analytical skills, business acumen, and a passion for improving healthcare delivery. You will identify and advance Behavioral Health affordability opportunities by evaluating utilization trends, reimbursement gaps, medical necessity alignment, payment accuracy, and benefit design considerations. Through deep-dive analysis of claims, provider performance, and utilization patterns, you will uncover opportunities to optimize processes, strengthen financial stewardship, and support data-driven decision making across the Utilization Management organization.

Requirements

5+ years of related information technology professional experience.
Bachelor’s degree; in lieu of a degree, an additional two years of relevant experience beyond the qualifications listed above may be accepted.

Nice To Haves

Clinical background with Utilization Management and Behavioral Health experience.
Experience analyzing and interpreting complex data to identify trends, insights, and business opportunities.
Ability to communicate complex topics clearly and concisely, actively listen to anticipate stakeholder needs, and align others to drive informed decisions.
Ability to analyze complex information, evaluate options, and work cross-functionally to drive resolution and prevent recurrence.
Ability to effectively organize work, balance competing priorities, and manage time across complex assignments and competing deadlines.
Proficiency with business technology platforms, systems, software, and tools.
Understanding of business operations, processes, or domain context.
Ability to analyze information and support business decisions, solutions, or process outcomes.

Responsibilities

Develop and present data-driven business cases to support Utilization Management initiatives, evaluating clinical evidence, utilization trends, and potential cost-saving opportunities in partnership with Product, Clinical, and Operational stakeholders.
Analyze prior authorization and reimbursement opportunities, assessing the impact of benefit, coding, and utilization management changes to improve affordability and care quality outcomes.
Conduct operational and regulatory assessments of Utilization Management processes, identifying gaps, compliance considerations, and opportunities to align with state and federal requirements while improving efficiency.
Identify and recommend process improvement and affordability opportunities by combining operational insights, clinical criteria, financial modeling, and industry benchmarks to support strategic decision-making and drive measurable results.
Conducts in-depth research and analysis.
Analyzes, designs, develops, tests, debugs, implements, maintains and/or enhances new or existing systems or processes.
Develops and documents metrics and process changes.
Coordinates individual projects and related activities to ensure project/stories progress on schedule.
Maintains communication regarding project status, risks, issues, and priorities with project stakeholders and leadership.
Responsible for representing the customer and/or internal and external stakeholders while collaborating with business and technical units.
Oversight of internal or external downstream entities to ensure defined business requirement activities are fulfilled.
Identifies trends, emerging issues, and recommends best practices to ensure maximum results.
Acts as a liaison with internal and external partners to identify opportunities and needs.
Researches and develops implementation plans for meeting business needs.
Serves as senior subject matter expert associated with content, processes, and procedures.
May lead project teams and may provide training to junior level staff or other team members to achieve project milestones and objectives.
Performs additional responsibilities consistent with the scope and level of the role, as assigned.