A Career of Your Calling

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.