Clinical Resolution Analyst Jobs in Minnesota (NOW HIRING)

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'll Have Blue Cross and Blue Shield of Minnesota is seeking a Senior Business Analyst to join our Utilization Management (UM) Product team, with a focus on Behavioral Health (BH). In this highly visible role, you will serve as the Behavioral Health subject matter expert, helping shape strategy and drive initiatives that improve affordability, quality, and member outcomes. Working closely with product leaders, clinical partners, and business stakeholders, you will translate complex behavioral health clinical and operational insights into actionable business requirements, impact analyses, and implementation plans that support enterprise priorities.
The ideal candidate brings strong analytical skills, business acumen, and a passion for improving healthcare delivery. You will identify and advance Behavioral Health affordability opportunities by evaluating utilization trends, reimbursement gaps, medical necessity alignment, payment accuracy, and benefit design considerations. Through deep-dive analysis of claims, provider performance, and utilization patterns, you will uncover opportunities to optimize processes, strengthen financial stewardship, and support data-driven decision making across the Utilization Management organization. What You'll Do

• Develop and present data-driven business cases to support Utilization Management initiatives, evaluating clinical evidence, utilization trends, and potential cost-saving opportunities in partnership with Product, Clinical, and Operational stakeholders.
• Analyze prior authorization and reimbursement opportunities, assessing the impact of benefit, coding, and utilization management changes to improve affordability and care quality outcomes.
• Conduct operational and regulatory assessments of Utilization Management processes, identifying gaps, compliance considerations, and opportunities to align with state and federal requirements while improving efficiency.
• Identify and recommend process improvement and affordability opportunities by combining operational insights, clinical criteria, financial modeling, and industry benchmarks to support strategic decision-making and drive measurable results.

How You'll Do It

• Conducts in-depth research and analysis.
• Analyzes, designs, develops, tests, debugs, implements, maintains and/or enhances new or existing systems or processes.
• Develops and documents metrics and process changes.
• Coordinates individual projects and related activities to ensure project/stories progress on schedule.
• Maintains communication regarding project status, risks, issues, and priorities with project stakeholders and leadership.
• Responsible for representing the customer and/or internal and external stakeholders while collaborating with business and technical units.
• Oversight of internal or external downstream entities to ensure defined business requirement activities are fulfilled.
• Identifies trends, emerging issues, and recommends best practices to ensure maximum results.
• Acts as a liaison with internal and external partners to identify opportunities and needs. Researches and develops implementation plans for meeting business needs.
• Serves as senior subject matter expert associated with content, processes, and procedures.
• May lead project teams and may provide training to junior level staff or other team members to achieve project milestones and objectives.
• Performs additional responsibilities consistent with the scope and level of the role, as assigned.

Required Skills & Experience

• 5+ years of related information technology professional experience.
• Bachelor's degree; in lieu of a degree, an additional two years of relevant experience beyond the qualifications listed above may be accepted.

Preferred Skills & Experience

• Clinical background with Utilization Management and Behavioral Health experience.
• Experience analyzing and interpreting complex data to identify trends, insights, and business opportunities.
• Ability to communicate complex topics clearly and concisely, actively listen to anticipate stakeholder needs, and align others to drive informed decisions.
• Ability to analyze complex information, evaluate options, and work cross-functionally to drive resolution and prevent recurrence.
• Ability to effectively organize work, balance competing priorities, and manage time across complex assignments and competing deadlines.
• Proficiency with business technology platforms, systems, software, and tools.
• Understanding of business operations, processes, or domain context.
• Ability to analyze information and support business decisions, solutions, or process outcomes.

Role Designation Hybrid

Role designation definition:

• Teleworking is working full time remote.
• Hybrid is a minimum of 2 days onsite.
• Onsite is full-time onsite.

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 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.

Equal Employment Opportunity Statement

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.

Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: talent.acquisition@bluecrossmn.com.

Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association.

Physical requirements.