Business Analyst III – Clinical Optimization… at Medica · Minnetonka

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

This Business Analyst III opportunity within Medica's Clinical Services division supports optimization, governance, compliance, configuration, analysis, and continuous improvement of clinical operations, systems, business rules, communications, and data processes across multiple lines of business. This role serves as a key liaison between business, clinical, technical, compliance, and vendor partners to ensure regulatory compliance, operational efficiency, system effectiveness, and high-quality member and provider experiences.

This position plays a key role in supporting ongoing operations through analytical expertise, regulatory knowledge, and cross-functional collaboration to support ongoing operations and deliver continuous improvement across Clinical Services. Performs other duties as assigned.

Key Accountabilities

• Requirements & Solution Development

  • Analyze and document business processes, system requirements, workflows, business rules, and operational procedures supporting Clinical Services.
  • Translate business, clinical, operational, and regulatory requirements into clear functional and technical requirements.
  • Partner with Clinical Operations, Compliance, IT, Product, vendors, and business stakeholders to design and implement business and system solutions.

• Ongoing Support & Process Optimization

• • Maintain and update business process documentation, workflows, business rules, and operational procedures.
    • Identify opportunities for process improvement, operational efficiency, and system optimization.
    • Support continuous enhancement of clinical systems and related operational processes

• System Expertise & Stakeholder Support

• • Serve as a subject matter expert (SME) for clinical systems, clinical communications and letter management platforms, business rules, and operational processes.
    • Provide guidance and support to business, operational, and technical stakeholders regarding system functionality and business processes.
    • Collaborate cross-functionally to resolve issues, support implementations, and ensure successful adoption of solutions.

• Data, Reporting & Governance

• • Ensure business rules, system requirements, and operational processes align with organizational, clinical, and regulatory standards.
    • Support governance activities through accurate documentation, requirements traceability, and process compliance.
    • Utilize process and system knowledge to support data integrity, reporting requirements, and decision-making activities.

Required Qualifications

• Bachelor's degree or equivalent experience in related field
• 5+ years of relevant experience in business analysis, preferably in healthcare or clinical systems
• 3+ years of experience working in a health plan
• Experience working with cross-functional teams, including IT and business stakeholders
• Strong analytical and problem-solving skills with attention to detail
• Ability to translate complex business needs into actionable requirements
• Excellent communication and stakeholder collaboration skills
• Strong organizational skills with ability to manage competing priorities
• Ability to work independently and drive outcomes in a fast-paced environment

Preferred Qualifications

• Experience with clinical systems, utilization management, or care management workflows
• Proficiency in data and reporting tools (e.g., SQL, Excel, Power BI, Tableau, JIRA)
• Experience working with vendor-managed platforms and integrations

This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, or Madison, WI.

The full salary grade for this position is $78,700 - $134,900. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $78,700 - $118,020. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data.  In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica’s compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.