Data Analyst (Grievance and Appeals Resolution Services (GARS))

CalOptima

CalOptima Health is seeking a highly motivated an experienced Data Analyst (Grievance and Appeals Resolution Services (GARS)) to join our team. The Data Analyst for Grievance and Appeals Resolution Services (GARS) supports the data management reporting requirements of the GARS department. The incumbent will be responsible for developing and designing GARS reports and maintaining internal systems to support the business requirements of the department. The incumbent will continually develop database reports including the design process, table building, maintaining data integrity and conditioning of data applications. The incumbent will assist with exception reports to ensure routine, timely and accurate case completion. The incumbent will provide input and data analysis to capture trends in GARS.

Position Information:

Department: Grievance & Appeals

Salary Grade: 309 - $68,015 - $108,824 ($32.70 - $52.3192)

Work Arrangement: Partial Telework

**This position is eligible for telework in California.**

Duties & Responsibilities:

95% - 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 GARS processing environment or the data warehouse.

Provides expertise in data analysis, including member and provider GARS data.

Maintains a thorough knowledge of CalOptima Health's GARS data reporting requirements, Department of Health Care Services data reporting requirements and Centers for Medicare & Medicaid Services data reporting requirements.

Monitors and reports on any changes that affect CalOptima Health and/or health networks.

Provides assistance and input to the Data Analyst/s in the GARS department to improve the process in evaluating data and meeting department specifications and business needs.

Devises or modifies procedures to solve complex problems considering computer equipment capacity and limitations, operating time and form of desired results.

Participates in progressively more complex projects.

Assists in the design of provider dispute resolution claims reports from Facets, as needed.

Provides feedback to management to resolve data integrity issues and provides support for new reporting requirements.

Responsible for internal and external routine and ad-hoc reports or GARS related projects.

Develops Structured Query Language (SQL) queries to analyze and report on GARS ad hoc requests.

5% - Completes other projects and duties as assigned.

Minimum Qualifications:

Bachelor's degree in a related field PLUS 3 years as a data analyst or in a similar role that would provide the knowledge and abilities listed 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.

3 years of experience with the following Microsoft Office tools: SQL Server, Word, Excel (MS Project and Visio a plus) required.

3 years using Microsoft Access and/or Excel to produce charts, spreadsheets, pivot tables and/or other information applicable to position assignment required.

Preferred Qualifications:

1 year of experience with Grievance and Appeals strongly preferred.

Health maintenance organization (HMO), Medi-Cal, Medicare and health services experience.

3 years of system testing, reporting requirements and documentation skills.

Required Licensure / Certifications:

n/a

Knowledge & Abilities:

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.

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 less than 10 pounds

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.

About CalOptima Health:

CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto "Better. Together. is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay!

About our Benefits & Wellness options:

At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the alliantbenefits.cld.bz/24caloptimacabenguide regarding our comprehensive benefits and wellness package.

IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS

Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is September 4, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date.

The selection process may include, but is not limited to, a skills assessment, phone screen and interview.

The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet.

Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application.

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 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: apptrkr.com/5561362

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