Sr. Clinical Business Analyst

bcbst; United States; Remote; USD 90,000 - 120,000; Full time

Benefits offered by this job

Remote work

Job summary

BCBST is seeking a Sr. Clinical Business Analyst to support the Medical Policy Research & Development team by applying evidence-based practices, process improvement, and AI-enabled solutions to advance medical policy operations.

You will conduct literature surveillance, monitor regulatory changes, and work with clinical, operations, IT, and analytics to translate needs into clear requirements, ensuring governance and compliance across projects.

Qualifications

• Bachelor's Degree required or equivalent professional experience.
• 3 years of experience in clinical operations, care management, utilization management, or a comparable healthcare setting.
• 2 years of experience in reporting, data analysis, or performance improvement.
• 1 year of experience supporting projects or cross-functional workgroups; project management preferred.
• Experience evaluating AI-enabled or advanced analytics solutions and their workflow impacts.

Responsibilities

• Analyze clinical, operational, and financial data to identify opportunities to improve quality, utilization, access, and service delivery.
• Lead workflow and process analysis, recommending and implementing evidence-based improvements to enhance efficiency and outcomes.
• Translate clinical and business needs into clear requirements and actionable insights in partnership with clinical, operations, IT, and analytics teams.
• Provide subject-matter expertise and education on clinical workflows, data interpretation, reporting, and system functionality.
• Ensure compliance with regulatory, accreditation, and internal governance standards related to clinical operations and data use.
• Support the evaluation, implementation, and optimization of clinical and business processes, applications, and technology-enabled solutions.
• Assess, plan, and support responsible adoption of AI initiatives, including use case evaluation, requirements definition, and performance monitoring.
• Analyze adoption, performance, and outcome data for technology solutions, identifying risks and opportunities for optimization.
• Contribute to policies, controls, and governance frameworks for the use of technology in clinical and operational environments.

Skills

Analytical thinking

Clinical business analysis

Requirements gathering

Cross-functional collaboration

AI-enabled tools understanding

Regulatory compliance

Communication skills

Education

Bachelor's Degree

Equivalent professional experience (4 years)

Tools

Microsoft Office

Excel

SQL (basic)

Data visualization tools

Job description

We are hiring a Sr. Clinical Business Analyst at BCBST!

In this role, you will support the Medical Policy Research & Development team by advancing medical policy operations through the use of evidence-based practices, process improvement, and AI-enabled solutions. You will help drive the development and maintenance of medical policies by conducting literature surveillance, monitoring regulatory and clinical guideline changes, and supporting interoperability and healthcare digitization initiatives. Your work will help improve operational efficiency, strengthen policy governance, and ensure timely implementation of evolving clinical and regulatory requirements.

To be successful in this role, in addition to the core job requirements, you'll bring strong analytical skills, medical policy knowledge, and experience leveraging technology to improve business processes. You will be a strong candidate for this role if you have experience with:

• Medical policy development, research, or clinical business analysis
• AI-enabled tools and technologies used to support healthcare operations
• Literature reviews, environmental scanning, and monitoring emerging clinical evidence
• Regulatory compliance, accreditation standards, and healthcare policy requirements
• Validating and quality-checking AI-generated outputs against primary source materials
• Supporting interoperability, prior authorization, and healthcare digitization initiatives
• Collaborating with cross-functional stakeholders to implement policy and operational changes
• Maintaining system configurations, policy management tools, or related operational infrastructure
• Process improvement and workflow optimization within a healthcare environment

Note:

This is a remote role. Candidates should have demonstrated proficiency and comfort working with AI-enabled technologies and tools.

Job Responsibilities

• Analyze clinical, operational, and financial data to identify opportunities to improve quality, utilization, access, and service delivery.
• Lead workflow and process analysis, recommending and implementing evidence-based improvements to enhance efficiency and outcomes.
• Translate clinical and business needs into clear requirements and actionable insights in partnership with clinical, operations, IT, and analytics teams.
• Provide subject-matter expertise and education on clinical workflows, data interpretation, reporting, and system functionality.
• Ensure compliance with regulatory, accreditation, and internal governance standards related to clinical operations and data use.
• Support the evaluation, implementation, and optimization of clinical and business processes, applications, and technology-enabled solutions.
• Assess, plan, and support responsible adoption of AI initiatives, including use case evaluation, requirements definition, and performance monitoring.
• Analyze adoption, performance, and outcome data for technology solutions, identifying risks and opportunities for optimization.
• Contribute to policies, controls, and governance frameworks for the use of technology in clinical and operational environments.

Job Qualifications

Education

Bachelor's Degree required, or equivalent professional experience. Equivalent experience defined as 4 years of professional work experience in a healthcare, clinical operations, or corporate environment.

Licensure

Registered Nurse (RN) with an active license in the state of Tennessee or a compact state OR Master's-level Social Worker with an active Tennessee license (e.g., LMSW, LCSW)

Experience

• 3 years of experience in clinical operations, care management, utilization management, population health, or a comparable healthcare setting.
• 2 years of experience in reporting, data analysis, business analysis, or performance improvement.
• 1 year of experience supporting projects, initiatives, or cross-functional workgroups; project management experience preferred.
• Demonstrated experience collaborating with clinical, operational, and technical partners to improve workflows, systems, or performance outcomes.
• Experience evaluating and supporting AI-enabled or advanced analytics solutions, including understanding use cases, data inputs/outputs, limitations, and workflow impacts.

Skills & Competencies

• Strong analytical, critical thinking, and problem-solving abilities.
• Ability to translate clinical and operational needs into clear business requirements.
• Strong judgment related to risk, bias, appropriateness, and governance considerations for analytics and AI-driven tools in clinical settings.
• Proficient in Microsoft Office (Outlook, Word, Excel, Access, PowerPoint); advanced Excel skills preferred.
• Database reporting and data analysis experience.
• Ability to work independently with minimal supervision and collaboratively within a team environment.
• Proven ability to manage multiple projects, priorities, and timelines.
• Excellent oral and written communication skills, including the ability to present findings and recommendations to leadership.
• Strong interperso