Business Analyst Sr, Provider Data Operations - Covered

Business Analyst Sr, Provider Data Operations
- Covered California

Cal Optima

Join Us in this Amazing Opportunity

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 review and apply today and help us build healthier communities for all.

We are hoping you will join us as a Business Analyst Sr, Provider Data Operations
- Covered California and help shape the future of healthcare where you'll be an integral part of our Provider Data Operations team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Partial Telework
.

Telework requirements: 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 play a critical role in translating regulatory requirements and business objectives into clear reporting specifications, business rules and implementing operational workflows. You will partner closely with the Provider Data Operations (PDO) teams, Office of Compliance, Information Technology (IT), Claims Administration, Contracting and business stakeholders to ensure regulatory alignment, data accuracy and efficient delivery of reporting and system capabilities.

You will apply analytical expertise to evaluate business processes, identify opportunities, ensure reporting accuracy, compliance and alignment with organizational goals. Together, we are building a stronger, more equitable health system.

• 90% - Business Support
• 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.
• Leads the assessment, documentation and translation of business needs into detailed functional and technical requirements for provider data configuration updates.
• Ensures provider data configurations align with enterprise data governance standards and data quality expectations.
• Analyzes provider data workflows, identifies gaps and proposes enhancements to improve efficiency, accuracy and compliance.
• Collaborates with technical teams to design provider data rules, validations, mappings and configuration logic that support business operations and regulatory mandates.
• Supports migration and transition activities related to data conversion, crosswalk development and system rollout readiness.
• Provides subject matter expertise for provider data domains, including contracting, credentialing, directory, compliance and network management processes.
• Supports cross functional reporting initiatives to implement reports and processes that support regulatory requests, business operations and program outcomes.
• Conducts system research and testing to ensure reports produce expected results, maintains version control to ensure that all report documentation accurately reflects the current status, including changes and issues identified during testing.
• Maintains core competency in Provider Data Operations programs and organization operations, including regulatory requirements and business changes.
• Supports 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.
• Maintains an updated library of regulatory and business requirements, decisions, workflows, requirements and other documents critical to the department's data functions.
• Reviews ad-hoc analysis and generates reports as requested.
• 10% - Completes other projects and duties as assigned.

• 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 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.

• 2 years working in a business analyst or data analyst role.
• SQL experience.

• N/A

• Develop rapport and establish and maintain effective working relationships with Cal Optima Health's leadership and staff and external contacts at all…