Senior Business Analyst, Remote Claims – California

CalOptima Health Partnership; Florida; Remote; USD 78,000 - 125,000; Full time

Benefits offered by this job

Full Telework

Competitive compensation

Comprehensive benefits

Job summary

CalOptima Health is seeking a Senior Business Analyst, Sr, Claims, Covered California, to join our Claims Administration team. The role supports and advances regulatory compliance, system configuration, and analytical insights to optimize Covered California processes.

The position offers Full Telework with the requirement to operate within California. You will lead complex analyses, coordinate with cross-functional teams, and ensure timely, accurate results across multiple projects.

Qualifications

• Bachelor's degree in business administration, health care administration, health services or related field PLUS 3 years of experience in claims, managed care benefits and operational protocol in the health care industry required; an equivalent combination of education and experience may also qualify.
• 3 years of experience in Medi-Cal managed care or Medicare Advantage required.

Responsibilities

• Provides business support to the Claims Administration team and handles multiple concurrent projects.
• Leads analyses of regulatory notices and system configuration impacts on Covered California processes.
• Trains staff on system enhancements and changes driven by Covered California requirements.
• Supports executives with analytics on performance, trends and compliance.

Skills

Claims experience

Regulatory awareness

Analytical thinking

Communication skills

Education

Bachelor's degree in business administration/healthcare

Tools

Microsoft Office

Job description

CalOptima Health is seeking a Senior Business Analyst, Sr, Claims, Covered California, to join our Claims Administration team. The role supports and advances regulatory compliance, system configuration, and analytical insights to optimize Covered California processes.

The position offers Full Telework with the requirement to operate within California. You will lead complex analyses, coordinate with cross-functional teams, and ensure timely, accurate results across multiple projects.