Description

At 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.


Blue Cross and Blue Shield of Minnesota

Position Title: Senior Submissions Business Analyst
Location: Remote
Career Area: Information Technology


About Blue Cross and Blue Shield of Minnesota

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

Blue Cross and Blue Shield of Minnesota is hiring a Senior SubmissionsBusinessAnalyst in Eagan, MN. In this role, you will support the Submissions Team by performing data analysis, quality assurance, and regulatory submissions with a focus onaccurateandcompleteandMedicare Advantage (MA) data.You'llcollaborate withdataanalysts, actuaries,risk adjustment subject matter experts, other business analysts,andcross-functionalteams to deliveraccuratereports, resolvesubmission errors, and provide data-driven solutions.

This position requiresexpertisein healthcare data-including claims, membership, and provider information-along with hands-on experiencewithfile sets such as 837 claim files, MAO-002response files, and MAO-004response files. You will alsouse and collaborate viaPower BI dashboards andleverageexpert-level SQL skills to ensure compliance and actionable insights.

Qualified candidates will have a background in healthcare data, regulatory reporting skills, and a solid grasp of risk adjustment methodologies. Essential qualifications include hands-on experience with SQL, Power BI, and Medicare Advantageencounterdata submissions. Familiarity with CMS ACA EDGE, Minnesota Medicaid rejection reports, healthcare file formats, and CMS guidelines is highly valued. Strong problem-solving, communication, and collaboration abilities are crucial for guiding teams and supporting compliance in a fast-paced, regulated environment.

Your Responsibilities

• Conducts in-depth research and analysis.

• Identifiestrends, emerging issues and recommends best practices to ensure maximum results anddevelopsmetrics.

• Documentsmetrics and process changes.

• Effectively analyzes, designs, develops, tests, debugs, implements,maintainsand/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 communicationregardingproject status, risks, issues, and priorities with project sponsors and leadership.

• Acts as a liaison with internal partners and external partners toidentifyopportunities and needs andresearches/developsimplementation plans for meeting these needs.

• Responsible forrepresentingthe 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 teamsand mayprovide training tolower levelstaff to achieve project milestones andobjectives.

• Required Skills and Experience

• 5+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.

• Advanced collaborative, interpersonal,oraland written communication skills anddemonstratedability to developaccurateandappropriate communications.

• Advanced ability to communicate to all levels of management.

• Advanced research,analyticalandproblem solvingskills.

• Advanced skills in Microsoft Excel, Word, and Access.

• Strong ability to make decisions based on analysis and business needs.

• Advanced ability to bringa different perspectiveto 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.

Preferred Skills and Experience

• Encounter Data submissions experience with a focus on Medicare Advantage strongly preferred.

• Knowledge of CMS ACA EDGE, Medicare Advantageresponsefiles(MAOs) and/or Minnesota Medicaidrejection reports.

• Experience with managed care and health care claims

• Experience creating andmaintainingreporting in Power BI.

• At least 2 years of experience using SQL,use ofvarious databases and other data sources, and performing analytics.

• Familiarity with clinical coding (ICD-10-CM) and revenue cycles.

• Bachelor's degree.

• Knowledge of managed care and health care claimspreferred.

Compensation and Benefits:

Pay Range: $88,600.00 - $117,400.00 - $146,200.00 Annual

Pay 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.

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