Blue Shield Of California

Business Analyst, Senior

Blue Shield Of California • $100K — $120K *
Healthcare
5 - 7 years of experience
Job Overview by Ladders

Qualifications

  • Bachelor's degree or equivalent experience (4 years) in lieu of a degree
  • Minimum of 5 years relevant experience
  • Advanced knowledge of pharmacy benefit claims and operations
  • Proven ability to analyze financial discrepancies and improve processes
  • Strong communication skills with a solution-oriented approach
  • Excellent problem-solving and analytical skills
  • Proficient in Microsoft Excel and pharmacy claim data reporting

Responsibilities

  • Provide complex analytical support for cross-functional business operations
  • Develop annual operating plans, capital budgets, and business cases
  • Prepare and analyze reports for management review
  • Define business requirements to enhance operational efficiency
  • Support multiple complex projects with established work plans
  • Research funding discrepancies in collaboration with Finance and Data Analytics
  • Maintain accurate tracking of Pharmacy Funding and Administrative dollars
  • Oversee and enhance the Pharmacy funding process for accuracy and transparency

Benefits

  • Hybrid work model with in-office collaboration
  • Flexibility for employees living over 50 miles from office
  • Opportunity to work on complex, cross-functional projects
  • Engagement with various levels of management
  • Professional development through strategic oversight of funding operations
Full Job Description
Job Description

Your Role

The Pharmacy Finance Support team supports Pharmacy Strategy and Operations in managing impacts to the Pharmacy portfolio budget, ensuring proper approvals, and validating invoices from strategic vendors prior to payment. The Business Analyst, Senior will report to the Manager of Pharmacy Finance Support. In this role you will provide ownership and strategic oversight of Pharmacy funding and finance operations. This role partners with Finance, Data Analytics, external vendor partners, and business stakeholders to resolve discrepancies, strengthen processes, analyze and communicate pharmacy funding claim trends and outlier drivers, and ensure the accurate tracking and approval of Pharmacy funding.

Responsibilities

Your Work

In this role, you will:
  • Provide complex analytical support through the analysis and interpretation of data in support of cross-functional business operations
  • Develop annual operating plans, capital budgets and forecasts, and build business cases for new business initiatives (cost/benefit analysis)
  • Develop, prepare, and analyze reports with complex analysis and data for management review, and present to various levels of management
  • Define business requirements and provide analysis to increase operational efficiency
  • Provide analytical support for multiple, complex cross-functional projects simultaneously; establish work plans and timelines
  • Research funding and payment discrepancies in partnership with Finance, Data Analytics, and service providers; coordinate incident tickets and follow-through as needed
  • Maintain accurate tracking of Pharmacy Funding and Administrative dollars received and disbursed
  • Oversee and enhance the end-to-end Pharmacy funding process to improve accuracy, controls, timeliness, and transparency and provide backup support for Pharmacy Funding reconciliation and Pharmacy Service Provider administrative invoice validation.
  • Prepare and maintain external vendor partner Pharmacy Funding Pre-Approval documentation, annual estimates, and materials for executive approval
  • Perform other duties as assigned


Qualifications

Your Knowledge and Experience
  • Bachelor's degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree
  • Requires at least 5 years of prior relevant experience
  • Advanced knowledge in pharmacy benefit claims and pharmacy operations
  • Demonstrated ability to analyze financial discrepancies, improve processes, and coordinate work across multiple teams and external partners
  • Excellent verbal and written communication skills that exhibit a solution-oriented approach
  • Excellent problem-solving and analytical skills
  • Strong proficiency with Microsoft Excel and pharmacy claim data reporting


Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Please click here for further physical requirement detail.

About Blue Shield Of California

Blue Shield of California is a not-for-profit health plan provider that has been providing Californians with access to high-quality healthcare for over 80 years. The company offers a range of health insurance products and services to individuals, families, and employers. Blue Shield of California is committed to improving the health and wellbeing of its members and the communities it serves. The company is also committed to sustainability and has implemented a number of initiatives to reduce its environmental impact.
Learn more about Blue Shield Of California
Size
7,000 employees
Industry
Founded
1981

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