Business Analyst Sr (Covered California)

The Team You'll Join

We are a mission-driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to help us build healthier communities for all.

About the Role

We are seeking a Business Analyst Sr (Covered California) to join our Premium Billing & Member Enrollment team. This position has been approved to be Full Office. If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.

The Business Analyst Sr will be responsible for the analysis, development, implementation, and ongoing operational support of Covered California enrollment and premium billing functions for CalOptima Health. You will perform complex business analysis, process evaluation, documentation, reporting, issue resolution, and business-to-technology translation supporting multiple cross-functional initiatives.

You will collaborate closely with Operations Management, Information Technology, Finance, Customer Service, Office of Compliance, vendors, and delegated entities to analyze business needs, recommend solutions, improve operational processes, and support regulatory compliance. Additionally, you will translate business requirements, policies, and operational decisions into business requirements, workflows, test scenarios, procedures, and production support documentation.

Responsibilities

• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity, and accountability.
• Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
• Participates in design sessions to ensure business requirements are accurately translated into functional system solutions.
• Performs impact analysis for regulatory, operational, and system changes.
• Conducts gap analysis between current and future business processes.
• Evaluates business processes, identifies improvement opportunities, and recommends operational solutions.
• Analyzes production issues, identifies root causes, and recommends corrective actions.
• Develops business recommendations and supports analysis based on operational findings and business needs.
• Elicits, analyzes, documents, and validates business and system requirements while collaborating with business and technical stakeholders.
• Performs complex data analysis and develops reports and dashboards that support operational decision-making.
• Develops test scenarios, coordinates User Acceptance Testing (UAT), validates business functionality, and supports defect resolution.
• Conducts in-depth system research and testing, benchmarking functionalities against industry standards, engaging in exploratory testing, and implementing change management best practices.
• Supports cross-functional teams with process improvement initiatives and solutions based on data-driven insights.
• Translates regulatory requirements and operational decisions into clear procedures for operational staff.
• Collaborates with vendors and technical teams to validate system functionality, troubleshoot issues, and support successful implementation activities.
• Supports the implementation and operational readiness for end-to-end premium billing capability.
• Coordinates and tracks third-party vendors or delegated entity responsibilities related to complex enrollment and premium billing initiatives.
• Develops, organizes, and maintains detailed process documentation, standard operating procedures (SOPs), and complex desktop procedures.
• Maintains project documentation, including business requirements, deliverable trackers, test documentation, issue logs, and action items.
• Completes other projects and duties as assigned (10%).

Requirements

• Bachelor's degree in business, healthcare administration, finance, information systems, or related field PLUS 3 years of experience supporting system implementations or operational process improvement in health care operations, enrollment, billing, finance, or business analysis required. An equivalent combination of education and experience may also be qualifying.
• Experience in reporting and data analysis required.

Preferred Qualifications

• Experience in a managed care organization, IPA, health plan operations, or exchange environment.
• Experience supporting Covered California/ACA exchange operations.
• Experience with CalHEERS and exchange transaction processes, with EDI concepts including 834 transactions.
• Experience with core administration systems (e.g., Facets, QNXT) and billing platforms.
• Experience with Jira/Confluence, ServiceNow, Smartsheet, or MS Project.

Skills

• Develop rapport and establish and maintain effective working relationships with leadership, staff, and external contacts at all levels and with diverse backgrounds.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule; available to participate in evening and weekend events.
• Organize, be analytical, problem-solve, and possess project management skills.
• Work in a fast-paced environment and in an efficient manner.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Motivate and lead multi-program teams and external committees/coalitions.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job-specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Physical Requirements

• Ability to visually read information from computer screens, forms, and other printed materials and information.
• Ability to speak (enunciate) clearly in conversation and general communication.
• Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
• Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling, and prolonged sitting.
• Lifting and moving objects, patients, and/or equipment 10 to 25 pounds.

Benefits

• Competitive compensation: Pay Grade 311 - $77,863 - $124,581 ($37.43 - $59.8947/hour). The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role, and internal equity among other factors.
• Comprehensive benefits package.
• CalPERS pension program and additional retirement packages.
• Generous PTO program.
• Work-life balance initiatives.
• Various wellness programs.
• Tuition reimbursement.
• Professional development opportunities.
• Career development opportunities.
• Flexible scheduling.

Work Environment

If located at the 500, 505 Building or a remote work location:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• There are no harmful environmental conditions present for this job.
• The noise level in this work environment is usually moderate.

If located at PACE:

• Work is typically indoors in a clinical setting serving the frail and elderly.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.

If located in the community:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• Employee will occasionally work outdoors in varied temperatures.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.