Senior Business Analyst Remote Health Claims (CA)

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

Benefits offered by this job

Full Telework

Comprehensive benefits package

CalPERS pension program and retirement

Wellness programs

Job summary

CalOptima Health is seeking a Senior Business Analyst (Claims-Covered California) to support our Claims Administration team in translating complex business needs into analytical and reporting solutions. This role requires engaging with regulators and stakeholders while ensuring compliant claims processing and system configuration changes.

The position supports full telework within California, with occasional in-office requirements and a strong emphasis on collaboration across departments to

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 sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
• 3 years of experience in Medi-Cal managed care or Medicare Advantage required.

Responsibilities

• Lead advanced claims analyses and case research for Covered California and regulatory alignment.
• Analyze APLs, MedLearn notices and Medi-Cal bulletins to identify potential impacts on the department.
• Provide training on new Facets logic and support staff on regulatory guidance.
• Support staff on DMHC, DHCS, and CMS claims regulations and system configuration changes.

Education

Bachelor’s degree in business administration, health care administration, health services or related field

Job description

CalOptima Health is seeking a Senior Business Analyst (Claims-Covered California) to support our Claims Administration team in translating complex business needs into analytical and reporting solutions. This role requires engaging with regulators and stakeholders while ensuring compliant claims processing and system configuration changes.

The position supports full telework within California, with occasional in-office requirements and a strong emphasis on collaboration across departments to