Quality Configuration Assurance Analyst III

L.A. Care; Lancaster (CA); On-site; USD 92,000 - 151,000; Full time

Benefits offered by this job

Paid Time Off

Tuition Reimbursement

Retirement Plans

Medical, Dental and Vision

Wellness Program

Job summary

L.A. Care Health Plan in Los Angeles, CA is seeking a Quality Configuration Assurance Analyst III to lead the more complex QA work for configuring the Core System (QNXT) and related applications.

You will validate business requirements, perform deep testing, and ensure accurate configuration across surrounding systems to support member access and payments. The role requires at least 5 years in systems configuration for claims/health services, strong SDLC knowledge, and the ability to mentor

Qualifications

• At least 5 years of experience in Systems Configuration; Claims and Health Services/Population Health department.
• Advanced knowledge of health plan quality assurance related to claims, health services/population health and appeals.
• Knowledge of SDLC and change management methodologies, standards and best practices.
• Strong analytical, organization, and time management skills.

Responsibilities

• Identify, develop, and recommend new and/or enhanced testing specifications and related documentation.
• Serve as subject matter expert for QA of core and surround systems; perform complex QA audits.
• Conduct in-depth root cause analysis and propose process and configuration improvements.
• Collaborate with peers and management to ensure QA best practices and timely deliverables.
• Mentor junior staff and provide training as needed.

Skills

Managed care operations

SDLC knowledge

Analytical skills

Time management

Education

Bachelor's degree in business or related field

Master's degree in business or related field

Job description

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Quality Configuration Assurance Analyst III

Job Category: Claims

Department: Core Admin Ops - Configuration

Location: Los Angeles, CA, US, 90017

Position Type: Full Time

Requisition ID: 13403

Salary Range:$91,536.00(Min.) -$121,286.00(Mid.) -$151,034.00(Max.)

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

Job Summary

The Quality Configuration Assurance Analyst III is responsible for the more complex technical and analytical work related to the testing, validation, and quality assurance of business requirements for and the configuration of the L.A. Care Health Plan Core System (i.e., QNXT) and the related surround systems, applications, and database (e.g., Clinical CareAdvance (CCA), Process Communication Tracking (PCT), etc.). The Quality Configuration Assurance Analyst III collaborates closely with peers and management within the department as well as throughout the organization to facilitate the timely, accurate quality assurance of the systems configuration; in-depth analysis of major factors, root causes, etc. that impact member access to care, claims payments, etc.; and assessment and roll-out of key measures to facilitate improvement, where warranted. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.

Duties

Identify, develop, and recommend new and/or enhanced testing specifications and related documentation. Serve as a subject matter expert for the quality assurance of the configuration of the core and surround systems. Perform the most complex quality audits of the systems configuration. Conduct thorough, in-depth root cause analysis to help identify issues and provide well thought-out recommendations for proposed business process and systems configuration improvements, where warranted.

Interface and collaborate with peers within and outside of the department and the organization to support quality assurance best practices, business process and systems configuration improvements, product enhancements, compliance with established turnaround times and service levels, etc.

Applies subject expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the project’s/program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed.

Perform other duties as assigned.

Education Required

Bachelor's Degree in Business or Related Field

In lieu of degree, equivalent education and/or experience may be considered.

Education Preferred

Master's Degree in Business or Related Field

Experience

Required:

At least 5 years of experience in Systems Configuration; Claims and Health Services/Population Health department.

Advanced knowledge of and experience in health plan quality assurance (especially related to claims, health services/population health as well as appeals and grievances systems, applications, etc.)

Knowledge of and experience with utilizing SDLC and related change management methodologies, standards and best practices.

Preferred:

At least 5 years of experience working with a California Medi-Cal managed care plan or Commercial health plan, medical group, or management services organization.

Skills

Required:
Advanced understanding of managed care operations (including but not limited to, claims processing, population health, appeals and grievances, etc.) and the systems that support these operations.

Knowledge of Systems Development Life Cycle (SDLC) procedures in planning the quality assurance (i.e., use of rigorous documentation, testing, and quality assurance protocols pre- and post-deployment).

Strong analytical, organization, and time management skills.

Able to meet strict, tight deadlines with a high level of accuracy.

Able to prioritize multiple tasks.

Physical Requirements

Light

Additional Information

Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

L.A. Care offersa wide range of benefits including

• Paid Time Off (PTO)


• Tuition Reimbursement


• Retirement Plans


• Medical, Dental and Vision


• Wellness Program