Senior Claims Analyst – Full Telework (Remote)

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

Benefits offered by this job

Full Telework

Competitive pay

Benefits package

Flexible scheduling

Job summary

CalOptima Health is seeking a Senior Business Analyst for Claims (Covered California) to translate business needs into analytical solutions, support DMHC/DHCS/CMS regulatory requirements, and test system changes. The role focuses on advanced claims analyses, training, and cross-functional collaboration to improve compliance and efficiency.

The position supports the Claims Administration group, with potential for full telework within California and occasional in-office requirements.

Qualifications

• Bachelor's degree in business administration, health care administration, health services or related field.
• 3 years of experience in claims, managed care benefits and operational protocol in the health care industry.
• 3 years of experience in Medi-Cal managed care or Medicare Advantage.

Responsibilities

• Participates in mission-driven culture with a member focus on customer service, dignity and accountability.
• Leads multiple projects and workflows to ensure timely completion, including Covered California responsibilities.
• Provides analytical support and guidance on Covered California performance, trends and compliance.
• Trains staff on system enhancements and updates driven by Covered California requirements.

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 for Claims (Covered California) to translate business needs into analytical solutions, support DMHC/DHCS/CMS regulatory requirements, and test system changes. The role focuses on advanced claims analyses, training, and cross-functional collaboration to improve compliance and efficiency.

The position supports the Claims Administration group, with potential for full telework within California and occasional in-office requirements.