Quality Configuration Assurance Analyst III

L.A. Care Health Plan•Los Angeles, CA

10d•$91,536 - $151,034

About The Position

The Quality Configuration Assurance Analyst III performs complex technical and analytical work related to testing, validating, and assuring the quality of business requirements and configurations for L.A. Care Health Plan’s core system, QNXT, and related surround systems, applications, and databases, including Clinical CareAdvance (CCA) and Process Communication Tracking (PCT). The analyst collaborates with peers and management across the organization to support timely and accurate configuration quality assurance, analyze factors and root causes affecting member access to care and claims payments, and assess and roll out improvement measures where warranted. This role serves as a subject matter expert and resource for other staff. It applies specialized knowledge to evaluate business operations and processes, identify opportunities for technical solutions, ensure project and program deliverables meet departmental and organizational needs and applicable legislative policies and standards, provide training, recommend process improvements, and mentor junior staff and interns as needed.

Requirements

At least 5 years of experience in systems configuration and in a Claims and Health Services/Population Health department.
Advanced knowledge of and experience in health plan quality assurance, especially relating to claims, health services/population health, and appeals and grievances systems and applications.
Knowledge of and experience with SDLC and related change management methodologies, standards, and best practices.
Advanced understanding of managed care operations, including claims processing, population health, and appeals and grievances, and the systems supporting these operations.
Knowledge of Systems Development Life Cycle (SDLC) procedures for quality assurance planning, including rigorous documentation, testing, and pre- and post-deployment quality assurance protocols.
Strong analytical, organizational, and time management skills.
Ability to meet strict, tight deadlines with a high level of accuracy.
Ability to prioritize multiple tasks.
Bachelor's degree in Business or a related field; equivalent education and/or experience may be considered in lieu of a degree.

Nice To Haves

Master's degree in Business or a related field.
At least 5 years of experience working with a California Medi-Cal managed care plan, Commercial health plan, medical group, or management services organization.

Responsibilities

Identify, develop, and recommend new or enhanced testing specifications and related documentation.
Serve as a subject matter expert for quality assurance of core and surround systems configuration.
Perform the most complex quality audits of systems configuration.
Conduct thorough root cause analysis and recommend business process and systems configuration improvements where warranted.
Collaborate with peers within and outside the department and organization to support quality assurance best practices, process and configuration improvements, product enhancements, and compliance with turnaround times and service levels.
Evaluate business operations and processes and identify areas where technical solutions could improve performance.
Ensure project and program deliverables meet departmental and organizational needs, legislation, policies, standards, and best practices.
Provide training, recommend process improvements, and mentor junior staff and department interns as needed.
Perform other duties as assigned.