Senior Claims Analytics & Operations Lead (Remote)

SAN JOAQUIN COUNTY HEALTH COMMISSION; Modesto (CA); Remote; USD 97,000 - 140,000; Full time

Benefits offered by this job

Medical coverage (HMO/PPO)

Pension plan (CalPERS)

Paid time off (PTO)

Floating holidays

Tuition reimbursement

Remote work contingent on business

Wellness program

Dependent care FSAs

Job summary

SAN JOAQUIN COUNTY HEALTH COMMISSION is seeking a senior claims analytics lead to drive advanced analytics, workflow redesign, and system support for Claims Operations. The role emphasizes delivering executive-level materials and scalable processes, with the flexibility to work remotely based on business needs.

You will develop performance dashboards, run complex SQL queries, and build Excel models while partnering with leadership to align rules with QNXT, Jiva, and Symplr Payor.

Qualifications

• Five+ years in healthcare claims, business analysis, or related operations.
• SQL-based analytics experience (3+ years) and strong Excel skills.
• Experience with QNXT and Jiva is highly preferred.
• Ability to translate complex issues into executive-ready materials.

Responsibilities

• Provide advanced analysis, workflow redesign, and system logic support.
• Identify bottlenecks and redesign processes to improve outcomes.
• Create workflow maps, decision trees, and operational documentation.
• Develop specifications for configuration improvements and system changes.
• Run SQL queries to analyze claims data, trends, and routing behavior.
• Build dashboards and analytics for leadership review.

Skills

SQL proficiency

Advanced Excel

Workflow design

Leadership

Communication

Influence without authority

Education

Bachelor’s Degree

Tools

Visio

Lucidchart

Power BI

Tableau

QNXT

Jiva

Symplr Payor

Job description

SAN JOAQUIN COUNTY HEALTH COMMISSION is seeking a senior claims analytics lead to drive advanced analytics, workflow redesign, and system support for Claims Operations. The role emphasizes delivering executive-level materials and scalable processes, with the flexibility to work remotely based on business needs.

You will develop performance dashboards, run complex SQL queries, and build Excel models while partnering with leadership to align rules with QNXT, Jiva, and Symplr Payor.