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

The Principal Operations Analyst. will focus on establishing and refining operational processes related to CMS, federal and state, ERISA, BCBSA requirements for Commercial, Medicare and Medicaid products. This position will develop an oversight structure of the departmental and key stakeholder activities. This oversight structure will include the establishment of KPI's and program dashboards to measure performance and implementation of programs.

Your Responsibilities

• Provide operational oversight of pharmacy programs supporting Commercial, Medicare, and Medicaid products in alignment with CMS, federal and state regulations, and BCBSA requirements.

• Establish, document, and maintain oversight processes, policies, and internal controls for delegated pharmacy functions to proactively identify and mitigate operational and compliance risk.

• Develop, manage, and present pharmacy performance dashboards and KPIs, including claims, coverage decisions and appeals, formulary, networks, volume trending, quality outcomes, and performance guarantees.

• Partner with Compliance Officers and senior leadership to communicate operational performance, risks, and improvement opportunities through reporting and analytics.

• Lead cross-functional initiatives to enhance pharmacy processes and technology capabilities, partnering with IT, Pharmacy, Operations, Compliance, Audit, and Customer Experience/Service teams.

• Develop and manage project plans, timelines, stakeholders, and external vendor initiatives to ensure accurate, timely, and coordinated implementation of pharmacy programs and regulatory requirements.

• Oversee PBM and Pharmacy Analysts operational work across Commercial, Medicare, and Medicaid programs, ensuring quality, accuracy, and regulatory compliance.

• Manage operational requirements related to payment integrity, benefit configuration, data analysis, PDE/Encounter submissions, regulatory implementation, audit management, and regulatory reporting.

• Serve as a primary operational contact for regulatory and external entities including CMS, MN DHS, DOC, MDH, BCBSA, and ERISA-related requests.

• Oversee intake, investigation, and resolution of pharmacy-related inquiries from members, regulators, and internal partners.

• Monitor and manage vendor service level agreements and performance guarantees.

• Draft, maintain, and update administrative pharmacy policies aligned to operational responsibilities.

Required Skills and Experiences

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

• Professional experience in pharmacy at a health plan or PBM.

• Project management/relationship management experience required, preferably in the pharmacy or healthcare industry preferred.

• Strong data analysis and metrics/KPI development and monitoring.

• Experience in triaging and resolving inquiries associated to claims and benefits.

• Experience working Commercial, Medicare and/or Medicaid

• High school diploma (or equivalency) and legal authorization to work in the U.S.

Preferred Skills and Experiences

• Previous experience in pharmacy technician role, with or without certification

• PBM experience

• Bachelor’s degree

Compensation and Benefits:

Pay Range: $102,400.00 - $138,300.00 - $174,200.00 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.

Role Designation

Hybrid

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.

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.