Complaint Analyst

California Department of Managed Health Care; California; Hybrid; USD 67,000 - 84,000; Full time

Job summary

The California Department of Managed Health Care (DMHC) is seeking a Complaint Analyst to support the Standard Complaint Branch in Sacramento. The role involves evaluating and resolving standard complaints, monitoring health program activities, and providing clear guidance to members and health plans within a hybrid work setting.

You will operate under supervision with a focus on accuracy, independence, and timely communication, contributing to a stable, high-quality health care delivery system

Qualifications

• Knowledge of health care insurance principles, practices and trends.
• Ability to work in a fast-paced, customer-service oriented program environment and to organize/prioritize workload.
• Ability to work well under pressure and meet deadlines.
• Ability to perform multiple tasks with accuracy, precision and neatness.
• Ability to thrive in a team environment and provide clear, timely advice.
• Demonstrated ability to act independently with flexibility and tact.
• Proficiency with standard office software (Outlook, Word, Excel, Access, PowerPoint).

Responsibilities

• Evaluate, monitor and resolve standard complaints and health program activities within SCB.
• Provide accurate, clear, and timely guidance and direction.
• Work in a fast-paced, customer-service oriented environment and manage workload.
• Collaborate with team to address complex issues within program scope.
• Support program policies and procedures under supervision.

Skills

Customer service

Teamwork

Multi-tasking

Communication

Analytical thinking

Problem solving

Tools

MS Office

Job description

Job Description And Duties

The DMHC Help Center educates members about their health care rights and resolves complaints against health plans to ensure a stable and accessible health care delivery system. Under the direction of the Supervisor I, the Analyst II is assigned the more complex program-related responsibilities using the interpretation and implementation of the Knox-Keene Health Care Service Plan Act of 1975 (KKA), Title 28 of the California Code of Regulations (CCR), consumer/enrollee contracts, i.e., Evidence of Coverage, and program policies and procedures. The Standard Complaint Branch (SCB) incumbent is responsible for evaluating, monitoring and resolving standard complaints and health program activities, including complaints that have been forwarded by the Governor, Legislature, California Health & Human Services Agency, DMHC Director, or any of the DMHC's Executive offices. The incumbent will perform technical, consultative, and programmatic work within SCB.

Applicants must be authorized to work for ANY employer in the U.S. We are unable to sponsor or take over sponsorship of an employment Visa at this time.

Leave Program (PLP) 2025 agreement: Effective July 1, 2025, the California Department of Human Resources (CalHR) implemented the temporary Personal Leave Program 2025 (PLP 2025). PLP 2025 directs that each employee receive a temporary reduction in pay in exchange for PLP 2025 leave credits. The temporary salary reduction percentage and the number of PLP 2025 leave credits are based on the position’s associated bargaining unit. The salary range(s) included in this job advertisement do not include the temporary salary reduction.

You will find additional information about the job in the Duty Statement.

Working Conditions

The DMHC has locations in Downtown Sacramento and Rancho Cordova. Both locations are located close to light-rail with various amenities. The incumbent will work in a climate-controlled cubicle and/or office environment with artificial lighting. This position may be eligible for hybrid telework. In-person attendance is required based on the operational needs of the position and in accordance with Executive Order N-22-25 the Statewide Hybrid Telework Policy, Government Code section 14200, and any applicable department telework requirements. The successful candidate must reside in California at the time of appointment. Proof of California residency may be required.

Minimum Requirements

You will find the Minimum Requirements in the Class Specification.

Additional Documents

• Job Application Package Checklist
• Duty Statement

Position Details

Job Code #: JC-537268

Position #: 409-161-5393-141

Working Title: Complaint Analyst

Classification: ANALYST II

Salary: $6,031.00 - $7,547.00 A

New to State candidates will be hired into the minimum salary of the classification or minimum of alternate range when applicable.

# of Positions: Multiple

Work Location: Sacramento County

Telework: Hybrid

Job Type: Permanent, Full Time

Department Information

The mission of the Department of Managed Health Care (DMHC) is to ensure health plan members have access to equitable, high-quality, timely, and affordable health care within a stable health care delivery system. The DMHC accomplishes its mission by ensuring the health care system works for consumers. The Department protects the health care rights of Californians by regulating health care service plans, assisting consumers through a consumer Help Center, educating consumers on their rights and responsibilities and preserving the financial stability of the managed health care system.

DMHC values diversity at all levels of the organization and is committed to fostering an environment in which employees from a variety of backgrounds, cultures, and personal experiences are welcomed and can thrive. DMHC believes the diversity of our employees and their unique ideas inspire innovative solutions to further our mission. Join DMHC and help us improve the lives of all Californians.

Special Requirements

• The position(s) require(s) a Background Investigation be cleared prior to being hired.

All applicants not currently employed by the DMHC will be subject to a pre-employment background investigation. The investigation will consist of fingerprinting and an inquiry to the California Department of Justice to disclose criminal records.

Any documents you submit for a job vacancy such as your state application, resume, cover letter, educational transcripts, etc. SHOULD NOT include ANY confidential information. Confidential information that should be excluded or removed from these documents includes, but is not limited to, your Social Security Number (SSN), birthday, driver’s license number (unless required), basis of eligibility, examination results, LEAP status, marital status, and age. Confidential information on the first page of applications submitted electronically online, such as Easy ID number, SSN, examination related information, and driver’s license number will automatically be redacted upon submission.

Possession of Minimum Qualifications will be verified prior to interview and/or appointment. If you are using education to meet the minimum qualifications for this position, you must submit a copy of your high school transcripts or college/university transcript(s). Unofficial transcripts may be accepted during the application process; however, submission of official transcripts may be required prior to appointment.

Desirable Qualifications

• Knowledge of principles, practices, and trends with health care insurance;
• Ability to work in a fast-paced and customer service-oriented program environment and to organize/prioritize workload to meet demands;
• Ability to work well under pressure and meet deadlines;
• Ability to perform multiple tasks with accuracy, precision and neatness;
• Ability to thrive and work within a team environment;
• Ability to provide accurate, clear, and timely advice and direction;
• Independently resolve complex issues within a short timeframe;
• Provide excellent oral and written communications;
• Demonstrated ability to act independently, with open-mindedness, flexibility, and tact;
• Ability to cultivate collaborative and cohesive working relationships with people in and outside of the team;
• Knowledge and proficiency in the use of personal computers and standard office software (i.e. Outlook, Word, Excel, Access and PowerPoint.)

Benefits

Benefit information can be found on the CalHR website and the CalPERS website.

Contact Information

The Human Resources Contact is available to answer questions regarding the application process. The Hiring Unit Contact is available to answer questions regarding the position.

Department Website: http://www.dmhc.ca.gov

Human Resources Contact:
DMHC Recruitment
[phone]
[e-mail]

Hiring Unit Contact:
Weda Thao
[phone]
[e-mail]

Please direct requests for Reasonable Accommodations to the interview scheduler at the time the interview is being scheduled. You may direct any additional questions regarding Reasonable Accommodations or Equal Employment Opportunity for this position(s) to the Department's EEO Office.

EEO Contact:
EEO Office
[phone]
[e-mail]

California Relay Service: 1-800-735-2929 (TTY), 1-800-735-2922 (Voice) TTY is a Telecommunications Device for the Deaf, and is reachable only from phones equipped with a TTY Device.

Equal Opportunity Employer

The State of California is an equal opportunity employer to all, regardless of age, ancestry, color, disability (mental and physical), exercising the right to family care and medical leave, gender, gender expression, gender identity, genetic information, marital status, medical condition, military or veteran status, national origin, political affiliation, race, religious creed, sex (includes pregnancy, childbirth, breastfeeding and related medical conditions), and sexual orientation.

It is an objective of the State of California to achieve a drug-free work place. Any applicant for state employment will be expected to behave in accordance with this objective because the use of illegal drugs is inconsistent with the law of the State, the rules governing Civil Service, and the special trust placed in public servants.