Job Description

Claims Configuration Quality Assurance Analyst (CCQAA)

Location: Central Coast, CA (Hybrid or Onsite Preferred)

Compensation: $76,466 – $110,875

Reports To: Claims Configuration Manager or Department Lead

Our client, a respected healthcare organization serving the Central Coast, is seeking a Claims Configuration Quality Assurance Analyst (CCQAA) to serve as the in-house expert on Medi-Cal fee-for-service claims and benefit policy. This role will interpret policy updates, support provider contract automation, and lead claims configuration testing initiatives in collaboration with IT. The ideal candidate will be a detail-oriented analyst with strong knowledge of Medi-Cal and healthcare operations, capable of managing test plans, documenting results, and improving claims workflows.

Key Responsibilities:

• Design and execute test plans to validate claim configurations, detect defects, and document outcomes.
• Interpret Medi-Cal policy updates and apply them to claims and provider reimbursement practices.
• Analyze and resolve HIS system configuration issues.
• Maintain and test internal reference files (procedure codes, rates, modifiers, etc.) across all health programs.
• Collaborate with IT and Claims to improve or configure systems to meet new requirements.
• Coordinate acceptance testing and post-production reviews to identify areas for improvement.
• Support development of desk reviews and SCFs to streamline claims workflows.
• Create reports to analyze claims, identify retro adjustments, and assess financial impact of system changes.
• Partner with Customer Service and Provider Services to resolve claims-related issues.

Ideal Background:

• 3–5 years of experience in a healthcare setting (e.g., health plan, clinic, medical group).
• Deep understanding of Medi-Cal programs and fee schedules.
• Hands-on experience in claims configuration, healthcare systems testing, and process improvement.
• Proficient in Microsoft Office Suite, with advanced Excel skills.
• Familiarity with programming processes and medical terminology.

What Sets You Apart:

• Strong analytical and problem-solving skills.
• Exceptional attention to detail and organizational abilities.
• Ability to create thorough test cases based on technical specifications.
• Comfortable working independently while collaborating effectively across departments.
• Skilled in interpreting policy and translating it into system changes and operational workflows.

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