Business Analyst, Senior
Blue Shield Of California, Oakland, California, United States, 94616
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, drug lists, and 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, creating test 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.
Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Hybrid work environment: the in-office expectation is 8 days per month (approximately 2 days per week) out of the Oakland, Long Beach, or Rancho Cordova offices.
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 Create and coordinate test plans across multiple stakeholders 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 Hybrid work environment: the in-office expectation is 8 days per month (approximately 2 days per week) out of the Oakland, Long Beach, or Rancho Cordova offices. 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 Stellarus and the Ascendiun Family of Companies
Stellarus, launched in January 2025, is designed to scale innovative healthcare solutions that support customers in creating a health care experience deserving of their family, friends, and neighbors.
Stellarus is part of a family of organizations that is overseen by a nonprofit corporate entity named Ascendiun. The Ascendiun Family of Companies also includes Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan and Altais, a clinical services company.
Stellarus' vision is to empower its customers to create a healthcare experience that is worthy of their family, friends, and neighbors. Stellarus' objective is to offer innovative, modern, scalable solutions that challenge the health care status quo. This very closely aligns with Blue Shield of California's vision by using innovation to improve quality, affordability, and experience for members.
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.
Our Values:
At Stellarus, our core values of agility, trust, drive, courage and service shape our approach to developing innovative product offerings.
Our Workplace Model:
We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:
For most teams, this means coming into the office two days per week. Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need. 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.
The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.
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.
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, drug lists, and 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, creating test 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.
Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Hybrid work environment: the in-office expectation is 8 days per month (approximately 2 days per week) out of the Oakland, Long Beach, or Rancho Cordova offices.
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 Create and coordinate test plans across multiple stakeholders 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 Hybrid work environment: the in-office expectation is 8 days per month (approximately 2 days per week) out of the Oakland, Long Beach, or Rancho Cordova offices. 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 Stellarus and the Ascendiun Family of Companies
Stellarus, launched in January 2025, is designed to scale innovative healthcare solutions that support customers in creating a health care experience deserving of their family, friends, and neighbors.
Stellarus is part of a family of organizations that is overseen by a nonprofit corporate entity named Ascendiun. The Ascendiun Family of Companies also includes Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan and Altais, a clinical services company.
Stellarus' vision is to empower its customers to create a healthcare experience that is worthy of their family, friends, and neighbors. Stellarus' objective is to offer innovative, modern, scalable solutions that challenge the health care status quo. This very closely aligns with Blue Shield of California's vision by using innovation to improve quality, affordability, and experience for members.
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.
Our Values:
At Stellarus, our core values of agility, trust, drive, courage and service shape our approach to developing innovative product offerings.
Our Workplace Model:
We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:
For most teams, this means coming into the office two days per week. Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need. 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.
The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.
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.