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Member Data Analyst I

Member Data Analyst ILocation: Mariposa County, California; Merced County, California; Monterey County, California; San Benito County, California; Santa Cruz County, CaliforniaWe have an opportunity to join the Alliance as a Member Data Analyst I in the Member Data Management Department.WHAT YOU'LL BE RESPONSIBLE FORReporting to the Member Data Supervisor, this position:• Maintains the accuracy of member enrollment, Coordination of Benefits (COB) and Other Health Coverage (OHC) data, and Primary Care Provider (PCP) linkage data in Alliance information systems and those of its delegated sub-contractors to resolve the less complex eligibility, demographic, and coverage discrepancies that affect member access, utilization management, claims, and reporting.• Researches, analyzes and responds to escalated internal and external customer questions [member data questions] and issues concerning Alliance member eligibility, demographics, and coverage.ABOUT THE TEAMWe serve our members, providers, and partners with empathy through ongoing engagement, education, and support.We keep busy in our communities, ensuring that Alliance members have both knowledge of and access to the benefits to which they are entitled. That also means actively expanding and assisting our provider network, from recruitment to timely payment.In addition, to further advance the Alliance's efficiency and effectiveness we analyze operational processes to identify areas of improvement.WHAT YOU'LL NEED TO BE SUCCESSFULTo read the full position description, and list of requirements click here.• Knowledge of:• Working knowledge of research, analysis, and reporting methods.• Working knowledge of government contracted regulated health plans, eligibility requirements and their respective automated eligibility verification systems.• Working knowledge of the principles and practices of customer service.• Some knowledge of data transmission, eligibility file formats, HIPAA, and system and data analysis.• Some knowledge of Title 22 and 28 of the California Code of Regulations and Social Security Administration regulations relating to Medi-Cal eligibility.• Ability to:• Ability to learn California Medi-Cal program, Medi-Cal eligibility, the Medi-Cal Eligibility Data System (MEDS-Lite) and its HIPAA compliant portal.• Ability to analyze less complex eligibility issues from identification to resolution.• Ability to collect, interpret, evaluate data, and prepare comprehensive reports.• Ability to conduct research, gather, and interpret information and data, identify issues of concern, make logical recommendations for action, and present findings in a clear and organized manner.• Ability to produce organized, accurate and detail-oriented work and maintain accurate records.• Ability to enter, proofread, verify, analyze and audit data.• Education and Experience:• Bachelor's degree in Business, Healthcare, Public Administration or a related field and a minimum of two years of experience in public assistance, health care or human services which involved working with Management Information Systems and spreadsheets and performing data entry.• Master's degree may substitute for the required experience; or an equivalent combination of education and experience may be qualifying.OTHER INFORMATION• We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.• While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.• In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.The full compensation range for this position is listed by location below.The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).Typical areas in Zone 1: Bay Area, Sacramento, Los Angeles area, San Diego areaTypical areas in Zone 2: Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka areaZone 1 (Monterey, San Benito and Santa Cruz)$29.11-$46.58 USDZone 2 (Mariposa and Merced)$26.49-$42.39 USDOUR BENEFITSAvailable for all regular Alliance employees working more than 30 hours per week. Some benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance.• Medical, Dental and Vision Plans• Ample Paid Time Off• 12 Paid Holidays per year• 401(a) Retirement Plan• 457 Deferred Compensation Plan• Robust Health and Wellness Program• Onsite EV Charging StationsABOUT USWe are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet.The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employerAt this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.
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What You Should Know About Member Data Analyst I, Central California Alliance for Health

Join the Central California Alliance for Health as a Member Data Analyst I in beautiful Mariposa, CA, where you can thrive in a supportive and dynamic environment. In this role, you’ll be reporting to the Member Data Supervisor and play a key part in maintaining the accuracy of member enrollment and coordinating benefits data. You'll actually be helping to resolve eligibility, demographic, and coverage discrepancies, ensuring that our members have seamless access to essential healthcare services. Your expertise will not only contribute to analyzing internal and external inquiries but also support our mission of creating positive experiences for our members and providers. Imagine being at the heart of a dedicated team focused on enhancing operational processes while actively engaging with your community! Whether it’s addressing member questions or digging deep into data analysis, your contributions will truly make a difference. We’re looking for someone with a strong foundation in data analysis, customer service, and a thirst for knowledge around California's healthcare regulations. So, if you’re detail-oriented, passionate about improving health outcomes, and ready to advance your career, then this Member Data Analyst I position could be just what you’re looking for. Join us, and let’s make a lasting impact together!

Frequently Asked Questions (FAQs) for Member Data Analyst I Role at Central California Alliance for Health
What are the responsibilities of a Member Data Analyst I at Central California Alliance for Health?

As a Member Data Analyst I at Central California Alliance for Health, your primary responsibilities will include maintaining the accuracy of member enrollment, managing the coordination of benefits data, and addressing less complex eligibility discrepancies. You'll be instrumental in analyzing and responding to escalated inquiries about member eligibility, demographic information, and health coverage, ultimately ensuring our members receive the best possible service.

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What qualifications are needed for the Member Data Analyst I position at Central California Alliance for Health?

To qualify for the Member Data Analyst I role at Central California Alliance for Health, you should have a Bachelor's degree in fields like Business, Healthcare, or Public Administration, along with a minimum of two years of relevant experience in public assistance or health services. A Master's degree may substitute for the required experience. Familiarity with California Medi-Cal regulations and data analysis is also essential for success in this role.

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How does the Central California Alliance for Health support its Members Data Analyst I?

At Central California Alliance for Health, support for the Member Data Analyst I includes continuous professional development and a collaborative work culture. You'll be part of a team that emphasizes empathy and engagement, ensuring you have the resources and support you need to enhance members' experiences, navigate complex data issues, and actively contribute to improvements.

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Is the Member Data Analyst I position at Central California Alliance for Health remote-friendly?

Yes! The Member Data Analyst I position at Central California Alliance for Health is designed for a hybrid work environment. While interviews may be conducted remotely, the role allows flexibility, with certain in-office or community presence expected depending on business needs. This setup enables you to balance work with community engagement effectively.

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What benefits does a Member Data Analyst I receive at Central California Alliance for Health?

As a Member Data Analyst I with Central California Alliance for Health, you can enjoy a comprehensive benefits package including medical, dental, and vision plans, generous paid time off, a 401(a) retirement plan, and robust health and wellness programs. These offerings are designed to support a balanced workplace environment and your overall well-being.

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Common Interview Questions for Member Data Analyst I
What steps would you take to resolve a discrepancy in member data?

To resolve a discrepancy in member data, I would first gather all relevant information and details concerning the issue. Then, I would cross-reference the data against our eligibility verification systems, carry out data analysis, and conduct further research to identify the root cause. Finally, I would ensure an accurate update in the system and document the resolution process clearly.

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How do you ensure accuracy in your data analysis?

Ensuring accuracy in data analysis involves several steps, such as meticulously entering data, conducting regular audits, and cross-checking information with other sources. I also prioritize staying current with relevant regulations and procedures, which helps maintain the highest standards in the accuracy of the data I handle.

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Can you describe your experience with government health plans and their regulations?

In my previous roles, I have worked extensively with government health plans, particularly focusing on Medi-Cal eligibility and associated regulations. I understand the complex landscape of eligibility verification systems, and I keep myself informed about the latest regulatory changes, ensuring compliance and seamless data management.

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Discuss a time when you had to analyze and present data to a non-technical audience.

In a past project, I was tasked with presenting data analysis findings to a group of stakeholders who were not familiar with technical jargon. I focused on translating complex data into straightforward insights by using visuals and real-world examples, ensuring that they understood the implications for member access and service delivery.

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How do you prioritize multiple tasks as a Member Data Analyst I?

I prioritize multiple tasks by assessing deadlines and the impact of each task on member outcomes. I utilize project management tools to keep track of my responsibilities and regularly communicate with my team. This systematic approach helps me ensure that high-priority issues are addressed promptly while keeping all projects on track.

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What software or tools are you familiar with for data management?

I am proficient in using various data management tools such as Microsoft Excel for data entry and analysis, as well as database management systems frequently used in healthcare. I also have experience with data visualization tools to present my findings effectively to team members and stakeholders.

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How do you handle confidentiality when dealing with member data?

Handling confidentiality is paramount in my work as a Member Data Analyst I. I ensure that I follow HIPAA regulations closely, only accessing necessary information and ensuring data is stored securely. I also advocate for best practices within my team to maintain a respectful environment for sensitive member information.

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What excites you about working in the healthcare sector, particularly as a data analyst?

I am excited about working in the healthcare sector because I truly believe in improving patients' access to care and overall health outcomes. As a data analyst, I see a unique opportunity to influence positive changes and efficiency in healthcare delivery through insightful analysis and actionable findings.

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Describe your method for conducting research related to eligibility and demographics.

My method for conducting research related to eligibility and demographics begins with defining the scope of the research question. I then utilize both quantitative and qualitative data sources, cross-referencing information and applying analytical techniques to derive insights. Finally, I synthesize my findings into comprehensive reports, sharing actionable recommendations.

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What is your understanding of the Medi-Cal program and its eligibility requirements?

I have a solid understanding of the Medi-Cal program, including its eligibility requirements, which hinge on factors such as income, residency, and specific health conditions. I stay informed about any changes to the eligibility criteria and work diligently to ensure that our databases reflect accurate and current information to facilitate member access.

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Full-time, hybrid
DATE POSTED
March 21, 2025

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