Business Analyst, Senior

Job Description

Your Role

The Formulary Management team leads the development and maintenance of multiple formularies to support competitive health plan products, manage cost-of-healthcare, and meet regulatory requirements for all lines of business including Commercial Large Group, Commercial Small Group, Individual/Family plan, and Medicare. The Business Analyst, Senior position will report to the Senior Manager of Formulary Management. In this role you will help determine requirements necessary for the build, implementation, and maintenance of formularies, including utilization management strategies. You will also lead in the creation of custom solutions to maintain compliance with state and federal mandates by interpreting mandates, gathering requirements from business owners, developing implementation plans, documenting system processes, and coordinating with cross functional business partners. You will act as subject matter expert to ensure formulary decisions and drug lists are implemented in accordance with business rules and regulatory requirements, and you may be asked to support audits or lead projects with minimal supervision and guidance.

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 for management review, and present to various levels of management
• Define business requirements and provide analysis to increase operational efficiency
• Analyze actual results against plan and forecast and recommend interventions where appropriate
• Identify opportunities for improvements in operation performance and notify management of issues and problems that require immediate attention
• Provide analytical support for multiple, complex cross-functional projects simultaneously, establishing work plans and timelines, and coordinating with internal and external resources
• Develop, review, and update written system processes and operational workflows related to formulary management
• Develop and implement work plan for formulary enhancements that support cost-of-healthcare initiatives
• Act as subject matter expert for formulary processes in support of state and federal mandates and audits
• Perform other duties as assigned

Qualifications

Your Knowledge and Experience

• Requires a college degree or equivalent experience
• Requires 5 years of prior relevant experience
• Experience working with Pharmacy Benefit Management systems or vendors
• Knowledge of Pharmacy Benefit design and Formulary configuration; knowledge of Blue Shield of California (or similar health care organization) pharmacy configuration is preferred
• Knowledge of regulatory requirements (Commercial and/or Medicare) related to formularies and utilization management
• Strong coordination and interpersonal skills working in a matrixed environment with multiple stakeholders
• Familiarity with Medispan drug files is preferred
• Knowledge of project management
• Demonstrated experience documenting processes, identifying process gaps, managing multiple projects, and implementing industry best practices
• Knowledge of Commercial and Medicare Part D formulary requirements is preferred
• Knowledge of California's pharmacy benefit compliance requirements is preferred

About the Team

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!

Our Values:

• Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model:

At Blue Shield of California and the Ascendiun Family of Companies, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose - whether working in the office or through a hybrid approach - by providing clear expectations while respecting the diverse needs of our workforce.

Two Ways of Working:

• Hybrid (Default): Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above).Exceptions:

o Member-facing and approved out-of-state roles remain remote.

o Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.

o For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

• On-Site: Work from a business unit-approved office an average of four (4) or more days a week.

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.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.