Medical Informatics Analyst, Principal

Job DescriptionYour Role The Healthcare Quality Affordability (HQA) Analytics team plays a key role in discovering information hidden in vast amounts of data that can lead to smarter decisions and deliver better service for our customers and contain the rising cost of healthcare. The Prior Authorization Medical Informatics Analyst, Principal will report to the Sr. Manager, HQA Analytics. Your focus will be in helping us strategize the prior authorization approach and applying rigor around the data analysis needed to make those decisions. The output of this analysis will be reported to several internal and external organizations.Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.ResponsibilitiesYour Work In this role, you will:Operate at a strategic business level to ensure projects/programs are in line with Blue Shield of California (BSC) strategic goalsWork cross-functionally to develop reporting for end-to-end prior authorization. This includes Network Management, Medical Management, and Claims and Pharmacy Collaborate closely with the Prior Authorization Program Manager and recommend strategic action for improving performance and commitments Develop strong, strategic partnership with internal and external stakeholdersUtilize and recommend enhancements to existing self-service reporting solutionsDevelop and maintain data driven strategy and operational reporting processes in support of the BSC prior authorization functionAnalyze data, build control reporting, and communicate changes to all levels of the BSC enterpriseUnderstand the data structures and sources, and the use of analytical or statistical tools to create meaningful insights that drive strategic action and resultsDesign, develop, and maintain interactive dashboards and data visualizations using Tableau and Power BI to support business insights and decision-makingQualificationsYour Knowledge and ExperienceRequires a college degree or equivalent experience Requires 10 years of prior relevant experience in Health Care (managed care, academic, or government payer)Requires SAS Certified Base Programmer Credential or equivalentRequires SAS Certified Advanced Programmer Credential or equivalentRequires mastery level knowledge of health data science typically obtained through advanced education combined with experience. May have deep knowledge of project managementAbility to function independently and produce results that meet standards of quality, timeliness, and acceptabilityProblem-solving skills balanced between "analytical" and "intuitive" Ability to thrive in ambiguous situationsExcellent verbal and written communication skills and the ability to interact professionally with a diverse group of executives, directors, managers, and subject matter expertsAbility to establish and maintain effective and collaborative relationships with key stakeholdersAdvanced skills using Microsoft Excel, Word, Visio, and PowerPoint in preparing and making presentations to various levels of management. Proficient at using MS ProjectTechnically proficient (having broad background) in problem solving toolsKnowledge of Blue Shield of California (BSC) or similar health care organization structureExtensive knowledge of CPT, HCPCS, ICD-10s and other related industry codesHybridThis role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.About the TeamAbout Blue Shield of CaliforniaAs of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies. At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience. To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us! Our Values: Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short. Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives. Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.Our Workplace Model We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility: For most teams, this means coming into the office two days per week. Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need. For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being. The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews. Physical Requirements:Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.Please click here for further physical requirement detail. Equal Employment Opportunity:External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

Created: 2026-04-15