Manager, Pharmacy Business Analysis

Your Role The Pharmacy Operations and Stabilization team provides end-to-end oversight of all Pharmacy benefit intent, quality assurance, testing, and production stabilization activities ensuring benefit changes are clearly defined, accurately validated, and effectively managed from issue identification through resolution within a matrixed environment. The Manager, Business Analysis will report to the Sr Manager, Operations and Stabilization. In this role you will manage the team who owns the end-to-end translation of pharmacy benefit intent into business requirements, operational frameworks, and quality validation strategies; provide consultative leadership across quality assurance (QA), testing, and production stabilization activities; and influence cross-functional decisions to resolve complex issues and improve benefit accuracy, operational performance, and governance across matrixed business, clinical, technical, and vendor teams.

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.

Your Work

In this role, you will:

• Provide analytical support through the analysis and interpretation of data in support of cross-functional business operations
• Contribute to annual operating plans, capital budgets and forecasts, and build business cases for new business initiatives (cost/benefit analysis)
• Develop, prepare and analyze reports for management review, and present to various levels of management
• Define business requirements and provide analysis to increase operational efficiency
• Analyze actual results against plan and forecast and recommend interventions where appropriate
• Translate pharmacy benefit intent, business needs, and operational inputs into clear requirements, process flows, test scenarios, and supporting documentation
• Support quality assurance and user acceptance testing by validating benefit configuration, documenting results, and coordinating defect resolution
• Analyze production issues, trends, and root cause indicators to support timely triage, escalation, remediation, and prevention efforts
• Partner with business, clinical, technical, and vendor teams to clarify requirements, resolve questions, and ensure alignment across implementation and stabilization activities
• Maintain dashboards, trackers, reports, and issue documentation to support operational visibility, leadership updates, and decision-making

Your Knowledge and Experience

• ​​Bachelor’s degree or High School Diploma/GED and 4 years of additional relevant experience
• ​Requires at least 7 years prior relevant experience, including 3 years of management experience gained as a team leader, supervisoror project/program manager
• Requires extensive experience with healthy plan pharmacy operations
• Requires experience translating business intent into business requirements, acceptance criteria, test scenarios, and operational validation plans
• Requires experience supporting quality assurance, user acceptance testing, regression testing, defect management, and post-implementation validation for pharmacy benefit or healthcare operations initiatives
• Preferred experience supporting large-scale pharmacy benefit implementations, annual benefit changes, product launches, client implementations, or system migration efforts

Hybrid This 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 Blue Shield of California

As 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.