BlueCard Business Analyst

Business Analyst – BlueCard Claims Operations

We are seeking a highly analytical and collaborative Business Analyst to support BlueCard daily operations and strategic initiatives within a fast-paced healthcare claims environment. This individual will play a critical role in resolving operational challenges, improving claims processes, and supporting a major HealthRules migration project impacting BlueCard operations.

The ideal candidate will bring deep end-to-end BlueCard knowledge, hands-on experience with the BlueSquared BCBSA application, and a strong understanding of healthcare claims processing workflows within a Blue Plan environment. This is a high-visibility role supporting large-scale initiatives with tight turnaround times, requiring someone who is proactive, curious, detail-oriented, and comfortable working closely with cross-functional teams.

This team is long-standing and highly collaborative, looking for someone who is willing to jump in where needed, ask questions, solve problems, and contribute to both daily operational support and future-state process improvements.

Key Responsibilities

• Support BlueCard claims operations through detailed analysis of claim issues, inquiries, and processing discrepancies
• Perform root cause analysis on incorrectly processed claims, failed DF/RFs, and operational defects while coordinating resolution efforts across teams
• Partner with Configuration, Account Management, IT, and Operations teams to improve claims processing accuracy and member experience
• Communicate and collaborate with other Blue Plans through the BlueSquared BCBSA application (RTM)
• Support the HealthRules migration project and other enterprise initiatives impacting BlueCard operations
• Evaluate current business processes and identify opportunities for workflow optimization, automation, and operational efficiencies
• Utilize data, reporting tools, bots, and technologies to drive continuous process improvement initiatives
• Assist with data extraction, reporting, documentation, testing, and maintenance of operational procedures and workflows
• Participate in User Acceptance Testing (UAT), system validation, and implementation support for enhancements and process changes
• Serve as a subject matter expert (SME) for BlueCard operational processes in meetings, projects, and cross-functional initiatives
• Share process improvement ideas and operational best practices across the team to promote continuous improvement and collaboration
  
  

Required Qualifications

• 3 years of experience in medical claims processing, healthcare operations, claims adjudication, or healthcare administration
• Strong end-to-end understanding of BlueCard operations and workflows within a Blue Plan environment
• Hands-on experience with the BlueSquared BCBSA application is required
• Strong understanding of healthcare claims processing, including ICD-10, CPT, HCPCS, and claims adjudication processes
• Experience performing root cause analysis and resolving claims processing discrepancies
• Working experience with SQL and Microsoft Access
• Advanced Microsoft Office skills, including Excel, Word, and PowerPoint
• Ability to analyze and summarize large data sets and identify operational trends or inefficiencies
• Strong communication skills with the ability to work effectively across business and technical teams
• Proven ability to work independently in a fast-paced environment with competing priorities and tight deadlines
• Strong attention to detail, critical thinking, and problem-solving skills
• Must possess a curious mindset and willingness to ask questions and learn from team members
  
  

Preferred Qualifications

• Tableau experience
• Experience supporting HealthRules or claims platform migration initiatives
• Exposure to automation tools, bots, or workflow optimization technologies
• Experience participating in process improvement or operational transformation initiatives within healthcare claims operations