Business Analyst, Consultant

The Clinical Coding team seeks an experienced Business Analyst, Consultant with strong analytical, business, and technical expertise to support complex, cross‑functional initiatives. This role is responsible for analyzing data, defining business requirements, and driving operational improvements related to payment policy, medical policy, and coding‑related processes, while also contributing to the development of annual operating plans, budgets, forecasts, and cost/benefit analyses for new initiatives. The Business Analyst, Consultant will report to the Sr. Manager, Clinical Coding and will play a critical role in ensuring payment and medical policy logic is accurately translated into system configuration, directly impacting claims accuracy, regulatory compliance, and cost of healthcare outcomes, while influencing cross‑functional decision‑making through expert analysis and identification of improvement opportunities. Responsibilities Provide highly complex analytical support through the analysis and interpretation of data to support cross‑functional business operations. Lead the development of annual operating plans, capital budgets and forecasts, and build business cases for new business initiatives (cost/benefit analysis). Develop, prepare, and analyze reports with highly complex analysis and data for management review, and present findings to various levels of management. Define business requirements and provide analysis to increase operational efficiency. Support multiple, highly complex cross‑functional projects simultaneously by establishing work plans, managing timelines, and coordinating with internal and external stakeholders. Manage critical programs including ClaimsXten monthly maintenance, release planning, and defect resolution to ensure accurate and timely claims adjudication. Translate payment policy, regulatory requirements (e.g., CMS, NCCI), and medical policy intent into system configuration and business rules. Partner cross‑functionally with Payment Integrity, IT, Medical Policy, and Operations teams to design and implement business solutions. Monitor operational performance and identify risks, gaps, and improvement opportunities to support cost of healthcare (CoHC) outcomes. Support audit readiness, compliance requirements, and provider dispute resolution through data analysis and documentation. Qualifications Requires a bachelor’s degree or equivalent experience. Requires at least 7 years of prior relevant experience. Requires deep knowledge of job area typically obtained through advanced education combined with experience. Requires strong knowledge of business analysis, payment policy, California state mandates and claims operations. Requires at least 3 years of payment policies and claims processing or equivalent experience. Familiarity with provider manuals, CMS/NCCI guidelines, and payment integrity operations. Requires knowledge of ClaimsXten or similar claims editing software. Strong analytical and problem‑solving skills with ability to conduct independent research and synthesize findings. Advanced knowledge and ability to perform process mapping, root‑cause analysis, gap analysis and requirements gathering. Requires practical knowledge of project management. Ability to deal with complexity, compressed timelines and shifting priorities. Proficient with MS Office products, including Word, PowerPoint and Excel; Visio expertise a plus. Strong interpersonal and verbal and written communication skills. Agile experience preferred. 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. 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 regard 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. Job Info Job Identification: 20260642 Job Category: Business and Data Analysis Posting Date: 2026-06-05T23:40:23+00:00 Job Schedule: Full time Locations: Woodland Hills, CA, United States Long Beach, CA, United States El Dorado Hills, CA, United States Oakland, CA, United States Rancho Cordova, CA, United States Redding, CA, United States San Diego, CA, United States Pay Range for California: $102,900.00 to $154,300.00 Pay Range for Bay Area: $115,900.00 to $174,000.00 Role can be filled by a candidate requiring sponsorship: No Note: The above pay ranges represent the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate experience, location (California, Bay Area, or outside California), and current employee salaries for similar roles. #J-18808-Ljbffr Blue Shield Of California