Business Analyst Sr, Provider Data Operations - Covered California

About the role

The Business Analyst Sr, Provider Data Operations - Covered California at CalOptima is a mission-driven position aimed at shaping the future of healthcare. This role requires a blend of analytical skills, strong communication, and a collaborative spirit.

Responsibilities

• Translate regulatory requirements and business objectives into clear reporting specifications, business rules, and operational workflows.
• Partner with the Provider Data Operations (PDO) teams, Office of Compliance, IT, Claims Administration, Contracting, and business stakeholders to ensure regulatory alignment, data accuracy, and efficient reporting.
• Evaluate business processes, identify opportunities, ensure reporting accuracy, compliance, and alignment with organizational goals.
• Apply analytical expertise to design provider data rules, validations, mappings, and configuration logic that support business operations and regulatory mandates.
• Support migration and transition activities related to data conversion, crosswalk development, and system rollout readiness.
• Support cross-functional reporting initiatives to implement reports and processes that support regulatory requests, business operations, and program outcomes.
• Conduct system research and testing to ensure reports produce expected results, maintain version control, and document changes and issues identified during testing.
• Maintain an updated library of regulatory and business requirements, decisions, workflows, requirements, and other documents critical to the department's data functions.
• Support planning, evaluation, and potential implementation of a new provider lifecycle management system and/or processes, including requirements gathering, system design considerations, testing, and change management activities.
• Provide subject matter expertise for provider data domains, including contracting, credentialing, directory, compliance, and network management processes.
• Lead the assessment, documentation, and translation of business needs into detailed functional and technical requirements for provider data configuration updates.
• Ensure provider data configurations align with enterprise data governance standards and data quality expectations.

Requirements

• Bachelor's degree in business administration, management, data science, or related field plus 3 years of experience in health care operations, provider data management, system implementation, or gathering of business requirements.
• SQL experience.

Qualifications

• Develops rapport and establishes effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
• Works independently and exercises sound judgment.
• Communicates clearly and concisely, both orally and in writing.
• Manages multiple projects and identifies opportunities for internal and external collaboration.
• Motivates and leads multi-program teams and external committees/coalitions.
• Utilizes 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.
• Ability to hear 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.