Quality Assurance Compliance Analyst - Remote CA

Socket.dev; West Sacramento (CA); Hybrid; USD 54,000 - 77,000; Full time

Benefits offered by this job

401(k) employer match

Health benefits

Educational assistance

Flexible vacation policy

Job summary

Gainwell Technologies is hiring a Quality Assurance Compliance Analyst to support QA and compliance activities across the Medi-Cal operations. You will review claims and processes, analyze data for quality trends, and ensure work aligns with policies and regulatory standards.

You will collaborate with claims, clinical, compliance and operations teams to identify improvement opportunities and strengthen overall quality and performance.

Qualifications

• Quality assurance and compliance experience in healthcare.
• Experience reviewing claims and operational processes for accuracy and regulatory compliance.
• Ability to analyze data to identify trends and issues.

Responsibilities

• Conduct quality reviews and audits of healthcare claims and operations for accuracy and compliance.
• Analyze claims data to identify trends, anomalies, and quality issues.
• Review claims, denials, appeals, provider enrollment and related activities for data accuracy and potential concerns.
• Document audit findings and communicate with stakeholders.
• Participate in root-cause analysis and recommend improvements.

Skills

Quality assurance

Compliance

Auditing

Healthcare operations

Data analysis

Communication

Education

High school diploma or GED

Bachelor’s degree or equivalent professional experience

Tools

EDMS

NICE CXone

MMIS

Job description

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development.

Summary

As a Quality Assurance Compliance Analyst at Gainwell, you will support quality and compliance activities across healthcare operations for the Medi-Cal account. You will review claims and operational processes, analyze data to identify quality trends and potential issues, and help ensure work is completed accurately and in accordance with established policies, regulatory requirements, and organizational standards.

You will partner with claims, clinical, compliance, and operational teams to identify opportunities for improvement and strengthen overall quality and performance.

Your role in our mission

• Conduct quality reviews and audits of healthcare claims and operational processes to evaluate accuracy, completeness, and compliance with established policies, procedures, and regulatory requirements.
• Analyze claims data to identify trends, anomalies, coding errors, quality issues, and opportunities for improvement.
• Review claims, denials, appeals, provider enrollment, and related operational activities to validate data accuracy and identify potential compliance or quality concerns.
• Document audit findings, maintain appropriate audit trails, analyze quality metrics, and communicate findings to operational and non-technical stakeholders.
• Participate in root-cause analysis and recommend corrective actions and process improvements based on audit findings and identified trends.
• Support compliance and regulatory reporting, internal and external audits, and quality improvement initiatives in collaboration with claims, clinical, compliance, and operational teams.

What we're looking for

• High school diploma or GED required; bachelor’s degree or equivalent professional experience preferred.
• Three or more years of experience in quality assurance, compliance, auditing, healthcare operations, claims, or a related field.
• Experience with healthcare claims adjudication, claims validation, denials, appeals, billing, or related healthcare operational processes.
• Knowledge of common claims quality issues, coding errors, and healthcare quality or compliance requirements.
• Familiarity with Medicaid or Medi-Cal operations and regulatory requirements, including DHCS or other applicable state regulatory or accreditation requirements, preferred.
• Experience analyzing data, identifying trends, conducting root-cause analysis, and supporting process improvement initiatives.
• Experience maintaining quality documentation, audit findings, and audit trails.
• Knowledge of systems such as EDMS, NICE CXone, or MMIS is a plus.
• Strong analytical, problem-solving, organizational, and communication skills with excellent attention to detail.

What you should expect in this role

• This position is primarily remote, with occasional in-office requirements at our West Sacramento, CA office based on business needs.
• Candidates must reside in California and be able to report to the West Sacramento office as needed.
• Travel requirements of approximately 0–10%.
• Video cameras must be used during all interviews.

We will be accepting applications for this position until October2, 2026.

#LI-REMOTE

#LI-MA1

The pay range for this position is$53,900.00-$77,000.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologiesis an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.