Business Analyst, Enrollment and Premium Billing
CalOptima
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.
More About the Opportunity
We are hoping you will join us as a Business Analyst-Enrollment and Premium Billing and help shape the future of healthcare where you'll be an integral part of our Customer Service 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 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 will be responsible for supporting the development, implementation and ongoing operationalization of Covered California enrollment and premium billing functions for CalOptima Health. You'll perform hands-on analysis, documentation, reporting, issue resolution support and business-to-technology translation. Additionally, you'll support department leadership and collaborate daily with the Operations Management, Information Technology, Finance, Customer Service and Office of Compliance departments, as well as with vendors and delegated entities. You'll also support enrollment file processing, premium billing processes, reconciliation and regulatory readiness. Finally, you'll translate policies and operational requirements into documented procedures, workflows, business requirements, test scenarios, trackers and production controls. Together, we are building a stronger, more equitable health system.
Your Contributions To the Team:
• 90% - Business Support and Operation
• 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.
• Analyzes enrollment discrepancies between CalHEERS/Covered California and CalOptima Health systems.
• Supports the daily buildout and ongoing monitoring of Covered California enrollment processes.
• Maintains enrollment exception logs, aging trackers and escalation documentation.
• Supports grace period workflows (30/60/90-day processing), including data tracking, member impacts and reporting.
• Assists in gathering, documenting and validating business requirements, collaborating with stakeholders to ensure clear and accessible documentation while collecting feedback from end-users.
• Develops business process workflows and use cases by analyzing current processes, identifying inefficiencies and iterating with stakeholders to enhance effectiveness.
• Supports system integration testing (SIT), user acceptance testing (UAT) and defect tracking by coordinating testing efforts, developing test cases and implementing a systematic defect tracking system.
• Provides analytical support and reporting through the review of ad-hoc reports and dashboards, generating regular reports that highlight key performance metrics and presenting actionable findings to stakeholders.
• Conducts in-depth system research and testing, benchmarking functionalities against industry standards, engaging in exploratory testing and implementing change management best practices.
• Assists with process improvement initiatives by identifying key performance indicators and supports cross-functional teams to implement solutions based on data-driven insights.
• Assists with the implementation and operational readiness for end-to-end premium billing capability.
• Performs manual reconciliation activities across systems to validate premium amounts and Advance Premium Tax, impacts and member billing accuracy.
• Assists with binder payment tracking and compliance reporting as required.
• Develops, organizes and maintains detailed process documentation, standard operating procedures (SOPs), desktop procedures and workflow diagrams.
• Translates regulatory requirements and operational decisions into clear procedures for operational staff.
• Supports with vendor data validation, integration and defect triage efforts.
• Assists in the coordination and tracking of third-party vendors or delegated entity responsibilities related to enrollment and billing.
• Maintains deliverable trackers, testing documentation, test scripts, issue logs and action item documentation.
• 10% - Other
• Completes other projects and duties as assigned.
Do You Have What the Role Requires?
• Bachelor's degree in business, healthcare administration, finance, information systems or related field PLUS 2 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 sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
You'll Stand Out More If You Possess the Following:
• 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.
What the Regulatory Agencies Need You to Possess?
• N/A
Your Knowledge & Abilities to Bring to this Role:
• Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and 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.
Your Physical Requirements (With or Without Accommodations):
• 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
Ways We Are Here For You
• You'll enjoy competitive compensation for this role.
• Our current hiring range is: Pay Grade: 310 - $72,096 - $115,353 ($34.66 - $55.4582).
• 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.
• This position is approved for Full Office (**If the position is Telework, it is eligible in California only**)
• A https://www.caloptima.org/en/careers#benefits
• CalPERS pension program and additional retirement packages.
• Additional benefits and perks including:
• A generous PTO program
• A quality work life balance
• Various wellness programs
• Tuition Reimbursement
• Professional development opportunities
• Career development opportunities
• Flexible scheduling
• And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.
Our 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.
Why Join Us?
We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare.
What's Your Next Step?
All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is March 26, 2026 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date.
Our Commitment to You
Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview.
If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet.
We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process.
CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together.
CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.
To apply, please visit: https://apptrkr.com/7000320
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