California Quality Assurance Analyst

Job Summary

Supporting quality and compliance activities across healthcare operations for the Medi-Cal account, the remote Quality Assurance Compliance Analyst will conduct audits, analyze claims data, and collaborate with various teams to enhance operational accuracy and compliance.

Key responsibilities

• Conduct quality reviews and audits of healthcare claims and operational processes for compliance and accuracy
• Analyze claims data to identify trends, anomalies, and opportunities for improvement
• Document audit findings and communicate results to operational and non-technical stakeholders

Required qualifications

• High school diploma or GED required; bachelor's degree or equivalent professional experience preferred
• Three or more years of experience in quality assurance, compliance, or healthcare operations
• Experience with healthcare claims adjudication, validation, and related operational processes
• Knowledge of Medicaid or Medi-Cal operations and regulatory requirements preferred
• Experience analyzing data and supporting process improvement initiatives