Data and Reporting Analyst Lead (Claims)

CalOptima Health is seeking a highly motivated and experienced Data and Reporting Analyst - Lead (Claims) to join our team.

The Data and Reporting Analyst - Lead is responsible for designing, developing, and maintaining databases to support business requirements of the team and continually improve data acquisition and reporting methods, which includes periodically reviewing the databases to enhance the processes and functionalities.

The incumbent will assist with the development of internal systems and exception reports to ensure timely and accurate claims adjudication.

The incumbent will develop and design reports, create and maintain databases to support the business requirements of the team, and continually improve data acquisition and reporting methods.

Do you have the skills to fill this role Read the complete details below, and make your application today.

Position Information :

• Department : Claims Administration
• Salary Grade : 314 - $99,902 - $159,843 ($48.03 - $76.8476)
• Work Arrangement : Partial Telework

This position is eligible for telework in California.

Duties & Responsibilities :

• 25% - Program 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.
• Designs reports from the claims processing environment or the data warehouse; responsible for ensuring data integrity.
• Serves as back-up to the supervisor in their absence.
• Participates in progressively more complex projects and performs progressively more complex analyses.
• 70% - Data & Reporting
• Provides expertise in data analysis, including member, provider, encounters, and claims data.
• Maintains a thorough knowledge of CalOptima Health's encounter data reporting requirements, DHCS data reporting requirements, and CMS data reporting requirements.
• Monitors and reports on any changes that affect CalOptima Health and / or health networks.
• Provides guidance / development and training to other Data Analysts in the Claims department to improve the process in evaluating data and meeting customer specifications and business needs.
• Acts as the point of contact for data requests, assigns requests to other Data Analysts, and monitors timelines and outcomes.
• Maintains databases to support business requirements and periodically reviews the databases to enhance the process and functionalities.
• Prepares ad-hoc analyses as needed.
• Devises and / or modifies procedures to solve complex problems considering computer equipment capacity and limitations, operating time, and form of desired results.
• Writes detailed business requirements for which technical requirements and programs will be developed.
• Prepares quality analytics (QA) methods to verify program and data integrity.
• 5% - Completes other projects and duties as assigned.

Minimum Qualifications :

• Bachelor's degree in health care administration, business administration, or related field required.
• 5 years of experience as a Data Analyst in designing, developing, and maintaining databases required.
• 3 years of experience with structured query language (SQL) 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.

Preferred Qualifications :

• 3 years of experience in Information Services related to health services.
• Experience in an independent physician association (IPA), hospital, or health plan setting.
• Experience with managed health care programs.

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