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 HaveThe 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.
Your 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.
- 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.
- 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
Anchored in Connection
Our hybrid approach is designed to balance flexibility with meaningful in-person connection and collaboration. We come together in the office two days each week – most teams designate at least one anchor day to ensure team interaction. These in-person moments foster relationships, creativity, and alignment. The rest of the week you are empowered to work remote.
Compensation and Benefits$90,800.00 - $120,300.00 - $149,800.00 AnnualPay 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 StatementAt 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 Affirmative Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic.
Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: [email protected].
Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.
Skills Required
- 5+ years of related professional experience
- High school diploma (or equivalency)
- Advanced collaborative, interpersonal, oral and written communication skills
- Project management skills
Blue Cross and Blue Shield of Minnesota Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Blue Cross and Blue Shield of Minnesota and has not been reviewed or approved by Blue Cross and Blue Shield of Minnesota.
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Retirement Support — The program combines a 401(k) match with additional company retirement contributions and a cash balance pension. This multi-pronged design strengthens long-term financial security beyond standard offerings.
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Parental & Family Support — Benefits include fully paid parental leave, adoption/surrogacy/foster assistance, and childcare support. These resources provide meaningful support across diverse family needs.
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Leave & Time Off Breadth — PTO that increases with tenure, multiple paid holidays, personal days, and paid volunteer time are paired with flexible scheduling. This breadth supports sustained work-life balance across career stages.
Blue Cross and Blue Shield of Minnesota Insights
What We Do
Blue Cross and Blue Shield of Minnesota is a taxable, nonprofit organization with a mission to make a healthy difference in people’s lives. Chartered in 1933 as Minnesota’s first health plan, we’ve promoted wider, more economical and timely availability of health services for the people of Minnesota for 80+ years. Blue Cross® and Blue Shield® of Minnesota is a nonprofit independent licensee of the Blue Cross® and Blue Shield® Association.
