Operations Oversight Analyst

Gold Coast Health Plan; California, Camarillo (MO, CA); Remote; USD 55,000 - 85,000; Full time

Job summary

An established industry player is seeking a detail-oriented professional to oversee operational processes and manage change control tasks. This role involves collaborating with internal departments to analyze trends and respond to provider inquiries, ensuring compliance and accuracy in claims processing. The ideal candidate will possess strong analytical and problem-solving skills, along with a commitment to diversity. With a flexible work schedule and travel opportunities, this position offers a dynamic work environment where your contributions will directly impact the quality of care provided to clients.

Qualifications

• 2+ years in claims processing or oversight, preferably as a senior analyst.
• Experience in Medi-Cal/Medicaid managed care is preferred.

Responsibilities

• Review claims and calls for accuracy and compliance.
• Coordinate communication with providers and delegates.
• Support change request prioritization and resolution.

Skills

Analytical Skills

Research Skills

Technical Skills

Financial Skills

Problem-Solving Skills

Diversity Awareness

Education

High School Diploma or GED

Tools

MS Office

Job description

Position Overview

Gold Coast Health Plan will not sponsor applicants for work visas. The salary range varies based on location and experience, with remote positions outside California having different pay bands. The role involves coordinating oversight of operational processes, managing change control tasks, and partnering with internal departments to analyze trends and respond to provider inquiries.

Key Details

• Travel: 30-50% to multiple sites
• Work Hours: Flexibility for beyond normal business hours

Essential Functions

• Review claims and calls for accuracy and compliance
• Validate implementation of Corrective Action Plans (CAPs)
• Coordinate communication with providers and delegates
• Support change request prioritization and resolution
• Track remediation activities and participate in provider education
• Review service level agreements and analyze reports
• Other duties as assigned

Qualifications

Skills include analytical, research, technical, financial, problem-solving, and diversity-oriented abilities. Education: High School diploma or GED required. Experience: 2+ years in claims processing or oversight, with preferred experience as a senior analyst or in Medi-Cal/Medicaid managed care. Computer skills: Proficiency in MS Office.