Top 8 quality analyst Jobs in riverside ca

Product Configuration Quality Analyst
Inland Empire Health Plan —Rancho Cucamonga, CA
- $80,059.20 - $106,059.20 a year
- Weekends as needed
- Hybrid work
- Microsoft Access
- Mid-level
- Office
- Disability insurance
- Health insurance
Analyst II - Test Governance & Coordination
Inland Empire Health Plan —Rancho Cucamonga, CA
- $80,059.20 - $106,059.20 a year
- Full-time
- Hybrid work
- Computer Science
- DevOps
- Research
- Disability insurance
- Health insurance
TikTok Shop - Data Analyst (Production & Quality Improvement)
TikTok —Fontana, CA
- $109,440 - $198,360 a year
- Mid-level
- 3 years
- Master's degree
- Paid parental leave
- Paid holidays
Quality Analyst
WFNTALENT —Redlands, CA
- Entry level
OluKai Product Development Analyst (SMU & Fit/Wear Testing)
OluKai-Kaenon-melin-Roark —Irvine, CA
- $72,000 - $85,000 a year
- Full-time
- Hybrid work
- Mid-level
- Office
- Bachelor's degree
- Paid holidays
- Health insurance
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quality analyst jobs near riverside ca

Product Configuration Quality Analyst

Inland Empire Health Plan -
Rancho Cucamonga, CA

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Job Details

Full-time
$80,059.20 - $106,059.20 a year

Benefits

457(b)
Disability insurance
Health insurance
On-site gym
Dental insurance
Flexible spending account
Vision insurance
Opportunities for advancement
Life insurance

Qualifications

National Correct Coding Initiative (NCCI) guidelines
Medicare
Managed care
Managed care organization experience
Health insurance policy knowledge
Configuration management
Centers for Medicare & Medicaid Services (CMS) billing regulations
Quality audits
Insurance claims auditing
Healthcare claims compliance audits
Quality assurance within healthcare

Full Job Description

Overview:

What you can expect!

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

Reporting to the Product System Configuration Supervisor, the Product Configuration Quality Analyst is responsible for ensuring the integrity of all claims system configuration created and maintained by the Product System Configuration team. The Product Configuration Quality Analyst audits claims system configured by the Application Architects and Analysts to ensure accurate adjudication of claims. Ensure all Business Rules are configured correctly in the claims system. Support testing efforts within an agile team and execute all levels of testing (System, Data validation, Integration and Regression). The Product Configuration Quality Analyst utilizes quality auditing tools, identifies trainings needs, and collaborates on effective and efficient methods for accurate and quality system configuration.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Additional Benefits:

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

Competitive salary
State of the art fitness center on-site
Medical Insurance with Dental and Vision
Life, short-term, and long-term disability options
Career advancement opportunities and professional development
Wellness programs that promote a healthy work-life balance
Flexible Spending Account – Health Care/Childcare
CalPERS retirement
457(b) option with a contribution match
Paid life insurance for employees
Pet care insurance

Key Responsibilities:

Audit team output, analyze and assess data reports, and validate system configuration accuracy against contract interpretation, business rules, and regulatory requirements. Ensure errors are corrected and escalated issues are resolved within a timely manner. Report findings and trends to leadership to further support requirements of accuracy and productivity.
Partner with the Product System Configuration Supervisor to define and uphold quality standards for Application Architects and Analysts performing claims system configuration (test coverage, evidence standards, defect SLAs).
Identify data integrity gaps, recommend process improvements, and flag training needs. Provide insights and feedback to Product System Configuration Supervisor.
Generate and audit quality reports (billing/handling practices, adjudication results, exception trends). Trigger improvement actions with Analysts.
Own the weekly review of the Claim Check Run Audit and reconcile issues/discrepancies.
Conduct in-depth root cause analysis of claims and integrated system configuration related issues that arise from claims and integrated system errors. Classify defects (e.g., large/difficult/complex) using quantitative thresholds and clear language.
Review regulatory guidelines to determine if claims system configuration updates are required. Identify, communicate, and present on impact of system enhancements or configuration changes on integrated systems and processes related to regulatory guideline updates. Track compliance in QA matrices.
Partner in the development of configuration standards and best practice guides for maintaining efficiency, accuracy, automation and successful integration with internal and external systems and programs.
Analyze and identify system configuration based on claims auto adjudication standard metrics and business operational requirements to identify systematic quality risks and control improvements.
Own and maintain a library of system requirements, specifications, test cases, defect logs, and test results. Ensure traceability from requirement to test evidence.
Own UAT (User Acceptance Testing) test plan preparation and test execution of product delivery initiative(s), crossing multiple applications.
Develop and run automated test scripts and evaluate results.
Work with Compliance teams to determine solutions to help comply with regulations, guidelines, and All Plan Letters (APLs). Attend DHCS meetings, as needed.
Develop and maintain policies, procedures, and training guidelines on behalf of the Product System Configuration team.
Assist with claims system configuration updates as needed.
Facilitate audit meetings to keep discussions focused, productive, and aligned with objective.
Perform any other duties as required to ensure Health Plan operations and department business needs are successful.

Qualifications:

Education & Requirements

Three (3) years of experience of auditing complex system configuration required
Three (3) years of experience in Managed Care required
Experience with claims review required
Experience in claims analysis/auditing preferred
Experience in major managed care system migration/implementation preferred
Bachelor’s degree in IT or Business from an accredited institution required
- In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this position: one (1) year of general healthcare experience plus three (3) years of claims analysis experience is required
- This experience is in addition to the minimum years listed in the Experience Requirements above

Key Qualifications

Comprehensive knowledge and understanding of:
- Regulatory compliance and how configuration changes affect regulatory adherence
- CPT, HCPCS, Revenue, ICD-10 Coding rules and guidelines
- General managed care operations and delegated plan models
- CMS, DHCS, DMHC, NCQA rules and regulations
- Encounters, EDI submissions, provider web portals, integrated NCCI applications, and overall data mapping
- System and application process integrations and algorithms
- Medicare, Medi-Cal, and Covered California benefit structure and regulatory billing guidelines
- Medicare, Medi-Cal, and Covered California claim processing guidelines
- Relational database structure
- Testing and audit methodologies
Strong skills in performing independent root cause analysis, developing test cases, and documenting findings
Skills in Microsoft Excel, Access, and SQL applications
Exceptional problem solving and critical thinking skills
Strong presentation and written communication skills
Ability to interpret regulatory changes and assess the need for configuration updates
Ability to identify training gaps and advise leadership on quality trends
Proven ability to:
- Operate as an independent reviewer and provide objective assessments under tight schedules
- Work independently and solve complex problems with little to no assistance
- Effectively manage competing priorities
- Ensure compliance and quality assurance standards are met
Schedule may adjust based on business need which may include evenings, holidays, and weekends to ensure completion of projects and to meet deadlines

Start your journey towards a thriving future with IEHP and apply TODAY!

Work Model Location:

This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA.)

Pay Range: USD $80,059.20 - USD $106,059.20 /Yr.

Apply Now

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quality analyst jobs in riverside ca

Product Configuration Quality Analyst

Analyst II - Test Governance & Coordination

TikTok Shop - Data Analyst (Production & Quality Improvement)

Quality Analyst

OluKai Product Development Analyst (SMU & Fit/Wear Testing)

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