Product Configuration Quality Analyst

IEHP

Product Configuration Quality Analyst at IEHP auditing claims system configurations and ensuring compliance with regulatory requirements. Collaborating in a hybrid model to support healthcare operations.

Posted 5/8/2026full-timeRancho Cucamonga • California • 🇺🇸 United StatesMid-LevelSenior💰 $80,059 - $106,059 per yearWebsite

About the role

Key responsibilities & impact

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.

Requirements

What you’ll need

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

Benefits

Comp & perks

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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

auditingdata analysissystem configurationclaims reviewroot cause analysisautomated testingUATtest case developmentdefect classificationcompliance tracking

Soft Skills

communicationproblem-solvingcollaborationattention to detailorganizational skillsleadershiptrainingreportingfeedbackfacilitation