Director – Center of Excellence and Quality Assurance
L.A. Care Health Plan
full-time
Posted on:
Location Type: Office
Location: Los Angeles • California • United States
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Salary
💰 $135,136 - $216,218 per year
Job Level
About the role
- Responsible for leading the quality, compliance, training, and continuous improvement functions.
- Builds a disciplined quality framework that strengthens upstream and downstream controls, enhances first-pass accuracy, and reduces defects.
- Oversees enterprise claims quality auditing, claims compliance oversight, issue detection and validation, and corrective action planning.
- Ensures the organization meets federal, state, and contractual requirements by maintaining effective monitoring, quality review programs, compliance validation, and documentation standards.
- Leads training and policy interpretation for claims-related operations.
- Serves as the primary partner to operational leaders on quality and compliance matters.
- Builds a high-performing team and fosters a culture of quality, operational rigor, accountability, and continuous improvement.
Requirements
- Bachelor's Degree
- At least 7 years of deep experience in claims quality, claims compliance, auditing, or related managed care administrative functions.
- At least 5 years of experience leading, supervising and/or managing staff.
- Experience in Medicaid, Medicare, and Commercial managed care lines of business.
- Extensive understanding of the application of the Division of Financial Responsibility (DoFR) to claims processing.
- Demonstrated experience leading enterprise audit programs or quality assurance functions.
- Experience interpreting regulatory requirements and applying them to operational workflows.
- Experience overseeing corrective action implementation, issue remediation, or regulatory readiness activities.
- Extensive experience supporting or preparing for regulatory audits.
Benefits
- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
- Volunteer Time Off (VTO)
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
claims qualityclaims complianceauditingquality assuranceregulatory requirementscorrective action planningissue detectioncompliance validationquality review programsenterprise audit programs
Soft skills
leadershipteam buildingoperational rigoraccountabilitycontinuous improvementpolicy interpretationcommunicationcollaborationtrainingproblem-solving
Certifications
Bachelor's Degree