AI Solutions Analyst (ITS Analyst Sr)

CalOptima Health Partnership; Orange (CA); Remote; USD 100,000 - 160,000; Full time

Benefits offered by this job

Full Telework

Comprehensive benefits

CalPERS pension

Generous PTO

Flexible scheduling

Tuition Reimbursement

Professional development

Career development

Wellness programs

Job summary

CalOptima Health seeks an AI Solutions Analyst Sr to lead the AI solution lifecycle, partnering with clinical and operations IT leaders to translate business problems into AI use cases. You will validate AI outputs, ensure governance and HIPAA compliance, and deliver outcome dashboards in Power BI across payer analytics functions.

You will collaborate with the AI Solutions Engineer, manage multiple use cases, and contribute to establishing an AI Community of Practice as the program grows.

Qualifications

• Bachelor’s degree in analytics, statistics, health informatics, computer science, business, or related field with 5 years of data analytics or business analysis experience.
• 2 years hands-on experience working with healthcare data (claims, eligibility, quality measures).

Responsibilities

• Lead AI use case identification, design, and governance with business leaders.
• Validate AI model outputs for accuracy, bias, and relevance before use.
• Build explainability dashboards in Power BI and report program value.
• Ensure HIPAA compliance and enterprise AI governance in analytics work.
• Collaborate with AI engineers and Enterprise Architecture on design decisions.

Skills

SQL

Data Analytics

Business Analysis

Healthcare Data

Power BI

Communication

Education

Bachelor’s degree in analytics/health informatics

Tools

Power BI

Azure AI

SQL

Job description

Join Us in this Amazing Opportunity

The Team You’ll Join

We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.

More About the Opportunity

We are hoping you will join us as a AI Solutions Analyst (ITS Analyst Sr)and help shape the future of healthcare where you’ll be an integral part of our IT - Data Warehouse and Analytics Technologyteam, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to beFull Telework.

• If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.

The AI Solutions Analyst will serve as a subject matter business analyst for the AI solution lifecycle, from opportunity identification and use case intake through implementation, adoption measurement, and outcome realization. You will lead this work and will be accountable for the quality and business relevance of the solutions delivered. You will identify and scope AI use cases and translate them into well-defined solution designs, partnering with clinical, quality, and operations Information Technology (IT) functional business leaders to define problem statements, document requirements, and establish how success will be measured. On each use case, the incumbent will work with the AI Solutions Engineer on technical build and Enterprise Architecture on design and platform decisions. A core responsibility is validating AI model outputs and downstream inferences for accuracy, consistency, business relevance, and algorithmic bias before results are acted upon, escalating any identified fairness or bias findings to the AI/ML Governance Committee for adjudication. You will measure and communicate AI program performance, adoption, and value to department leadership, including building explainability and outcome dashboards. As the program matures, the incumbent will help build an AI Community of Practice, enabling business unit AI Champions to identify, scope, and submit high-quality use cases. The AI Solutions Analyst will ensure AI-assisted workflows operate within Health Insurance Portability and Accountability Act (HIPAA) requirements, enterprise AI governance standards, and applicable vendor agreement obligations, partnering with cybersecurity, data governance, compliance, and analytics functions as needed. Together, we are building a stronger, more equitable health system.

Your Contributions To the Team:

• 90% - Technical Responsibilities
  • Participates in a mission-driven culture of high-quality performance with a member focus on customer service, consistency, dignity, and accountability.
  • Assists the team in carrying out departmental responsibilities and collaborates with others to support short- and long-term goals and priorities for the department.
  • Collaborates with clinical, quality, and operations IT functional business leaders to define business problems holistically before any AI solution is evaluated, ensuring use cases are grounded in clearly articulated business metrics and measurable outcomes.
  • Translates validated business problems into structured AI solution designs, documenting solution requirements, success criteria, data readiness assessments, and infrastructure dependency findings for each use case entering the governance pathway.
  • Validates AI model outputs for accuracy, consistency, hallucinations, and business relevance prior to business use.
  • Reviews AI model outputs across operational, clinical, and quality workflows to detect patterns where the AI may produce inconsistent or inequitable results across member populations.
  • Builds and maintains AI program explainability, adoption, and outcome dashboards within the organization’s Power BI environment, communicating to department leadership what the AI flagged, what was human-reviewed, model confidence levels, and program value against defined success criteria.
  • Establishes baseline metrics for each use case and tracks realized business value (productivity gains, cost avoidance, quality improvements, and member experience improvements) against defined success criteria, producing performance reports for leadership and governance committees.
  • Supports the development of an AI Community of Practice as the program matures, delivering use case scoping and feasibility conversations with business unit AI Champions and helping translate division-level ideas into structured intake submissions that meet program standards.
  • Supports user acceptance testing for AI-assisted clinical and operational workflows in partnership with the AI Solutions Engineer, with the analyst responsible for validating business outcomes and the engineer responsible for technical deployment.
  • Contributes analytical and business perspective during use case prioritization, assessing feasibility and expected value.
  • Queries and analyzes large-scale healthcare datasets (claims, eligibility, pharmacy, and quality data) using SQL and available low-code or no-code tooling to support data preparation, use case development, and program performance measurement. Ensures all AI-assisted workflows comply with HIPAA, PHI handling requirements, and enterprise AI governance standards; raises concerns proactively and partners with cybersecurity, data governance, compliance, and analytics teams as needed. Maintains clear, comprehensive documentation of analytical methodologies, AI output validation processes, solution design artifacts, and project deliverables.
  • Stays informed on emerging AI analytics practices, healthcare payer AI trends, and responsible AI principles, proactively recommending enhancements to the program’s analytical and validation approach.
  • Manages multiple projects simultaneously, ensuring timely delivery and alignment with stakeholder expectations.
• 10% - Other
  • Completes other projects and duties as assigned.

Do You Have What the Role Requires?

• Bachelor’s degree in analytics, statistics, health informatics, computer science, business, or a related field PLUS 5 years of professional experience in data analytics, business analysis, or a related discipline required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
• 2 years of hands-on experience working with healthcare data such as claims, eligibility, or quality measure data required.

You’ll Stand Out More If You Possess the Following:

• Familiarity with healthcare payer quality reporting requirements such as HEDIS, NCQA, or CMS.
• Experience evaluating AI or machine learning model outputs, including hallucination detection and algorithmic bias auditing.
• Demonstrated experience with prompt engineering or working with large language model-based tools in a professional setting.
• Lightweight Python scripting skills for data preparation, API calls, or automation of analytical workflows.
• Exposure to Azure AI services such as Azure OpenAI, Azure AI Document Intelligence, or Azure AI Foundry.
• Experience working within a regulated industry environment with strict data governance and compliance requirements (e.g., government, healthcare).
• Passionate about improving the US healthcare system and helping ensure every patient receives the best care possible.

What the Regulatory Agencies Need You to Possess?

• N/A

Your Knowledge & Abilities to Bring to this Role:

• Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule; available to participate in evening and weekend events.
• Organize, be analytical, problem-solve and possess project management skills.
• Work in a fast-paced environment and in an efficient manner.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Motivate and lead multi-program teams and external committees/coalitions.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Your Physical Requirements (With or Without Accommodations):

• Ability to visually read information from computer screens, forms and other printed materials and information.
• Ability to speak (enunciate) clearly in conversation and general communication.
• Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
• Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
• Lifting and moving objects, patients and/or equipment 10 to 25 pounds

Ways We Are Here For You

• You’ll enjoy competitive compensation for this role.
  • Our current hiring range is: Pay Grade:314 - $99,902 - $159,843 ($48.03 - $76.8476).
    • The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors.
• This position is approved for Full Telework(**If the position is Telework, it is eligible in California only**)
• comprehensive benefits package
• CalPERS pension program and additional retirement packages.
• Additional benefits and perks including:
  • A generous PTO program
  • A quality work life balance
  • Various wellness programs
  • Tuition Reimbursement
  • Professional development opportunities
  • Career development opportunities
  • Flexible scheduling
  • And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.

Our Work Environment:

If located at the 500, 505 Building or a remote work location:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• There are no harmful environmental conditions present for this job.
• The noise level in this work environment is usually moderate.

If located at PACE:

• Work is typically indoors in a clinical setting serving the frail and elderly.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.

If located in the Community:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• Employee will occasionally work outdoors in varied temperatures.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.

Why Join Us?

We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare.

CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.

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