Business Analyst Sr (Covered California)

CalOptima Health Partnership; Orange (CA); Hybrid; USD 78,000 - 125,000; Full time

Job summary

CalOptima Health Partnership is seeking a Senior Business Analyst (Covered California) to join the Premium Billing & Member Enrollment team. You will help shape future healthcare delivery by translating business needs into robust system solutions and supporting end-to-end premium billing initiatives.

The role requires collaboration with providers, vendors and internal stakeholders in a fast-paced, mission-driven environment.

Qualifications

• Bachelor’s degree in business, healthcare administration, finance, information systems or related field; 3+ years in health care operations, enrollment, billing, finance or business analysis.

Responsibilities

• Translates business requirements into functional system solutions.
• Develops impact and gap analyses for regulatory and operational changes.
• Creates data reports and dashboards to support decisions.
• Coordinates User Acceptance Testing (UAT) and validates functionality.
• Collaborates with vendors and technical teams for implementation activities.

Skills

Business analysis

Data analysis

User stories & requirements

UAT coordination

Cross-functional collaboration

Education

Bachelor's degree in business, healthcare administration, finance, information systems or related field

3 years experience in health care operations/analytics

Tools

Jira/Confluence

ServiceNow

Smartsheet

MS Project

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 Business Analyst Sr (Covered California) and help shape the future of healthcare where you’ll be an integral part of our Premium Billing & Member Enrollment team, 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 Office.

• 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.

Your Contributions To the Team:

• 90% - Business Support and Operation
  • 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 department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
  • Participates in design sessions to ensure business requirements are accurately translated into functional system solutions.
  • Performs impact analysis for regulatory, operational and system changes.
  • Conducts gap analysis between current and future business processes.
  • Evaluates business processes, identifies improvement opportunities and recommends operational solutions.
  • Analyzes production issues, identifies root causes and recommends corrective actions.
  • Develops business recommendations and supports analysis based on operational findings and business needs.
  • Elicits, analyzes, documents and validates business and system requirements while collaborating with business and technical stakeholders.
  • Performs complex data analysis and develops reports and dashboards that support operational decision-making.
  • Develops test scenarios, coordinates User Acceptance Testing (UAT), validates business functionality and supports defect resolution.
  • Conducts in-depth system research and testing, benchmarking functionalities against industry standards, engaging in exploratory testing and implementing change management best practices.
  • Supports cross-functional teams with process improvement initiatives and solutions based on data-driven insights.
  • Translates regulatory requirements and operational decisions into clear procedures for operational staff.
  • Collaborates with vendors and technical teams to validate system functionality, troubleshoot issues and support successful implementation activities.
  • Supports the implementation and operational readiness for end-to-end premium billing capability.
  • Coordinates and tracks third-party vendors or delegated entity responsibilities related to complex enrollment and premium billing initiatives
  • Develops, organizes and maintains detailed process documentation, standard operating procedures (SOPs) and complex desktop procedures.
  • Maintains project documentation, including business requirements, deliverable trackers, test documentation, issue logs and action items.
• 10% - Completes other projects and duties as assigned.

Do You Have What the Role Requires?

• Bachelor’s degree in business, healthcare administration, finance, information systems or related field PLUS 3 years of experience supporting system implementations or operational process improvement in health care operations, enrollment, billing, finance or business analysis 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.
• Experience in reporting and data analysis required.

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

• Experience in a managed care organization, IPA, health plan operations or exchange environment.
• Experience supporting Covered California/ACA exchange operations.
• Experience with CalHEERS and exchange transaction processes, with EDI concepts including 834 transactions.
• Experience with core administration systems (e.g., Facets, QNXT) and billing platforms.
• Experience with Jira/Confluence, ServiceNow, Smartsheet or MS Project.

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:311 - $77,863 - $124,581 ($37.43 - $59.8947).
    • 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.