Senior Manager, Quality Assurance and Compliance – Health Plan Operations

SCAN

Senior Manager of Quality Assurance and Compliance responsible for developing and implementing quality programs. Leading operational compliance in a healthcare organization serving older adults.

Posted 7/25/2026full-timeLong Beach • California • 🇺🇸 United StatesSenior💰 $125,400 - $181,419 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in developing and implementing Quality Assurance and Compliance programs, with a strong focus on operational processes, performance monitoring, and regulatory adherence in healthcare environments. Proven ability to lead teams, mentor professionals, and drive continuous improvement initiatives to enhance member satisfaction and operational efficiency.

Highest-signal resume keywords

Quality Assurance Program DevelopmentCompliance Reporting ManagementHealthcare Operations ExperienceAudit CertificationLeadership in Quality and Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Quality AssuranceCompliance ManagementPerformance MonitoringData Submission StandardsKPI AnalysisProcess ImprovementCorrective Action PlansOperational AuditsHealthcare RegulationsAI and Machine Learning Tools

Soft Skills

Team LeadershipMentoringCollaborationCommunicationProblem Solving

Certifications & Qualifications

Audit Certification

Industry Keywords

MedicareMedicaidHealthcare OperationsClaims ManagementProvider DataEnrollmentAppeals and GrievancesCMS RegulationsOperational StandardsMatrixed Environment

About the role

Key responsibilities & impact

Responsible for developing and implementing a quality assurance program, reviewing audits meet accuracy, timeless and contractual obligations, and enhancing operational processes
Partner with Operations leadership to design and develop an effective Quality Assurance and Compliance program gaining alignment on methodology, audit approach, KPIs, standards and issue resolution process
Manage quality and Compliance reporting
Coordinate accurate and timely submission of data, including audit readiness and documentation standards for Operations
Collaborate with operational partners to align workflows, address barriers to performance, and implement initiatives to enhance operations and member satisfaction
Monitor and communicate performance trends track and analyze key performance indicators (KPIs)
Share actionable insights and recommendations with senior leadership to inform strategic planning and resource allocation
Establish effective governance framework to include Audit the Auditor mechanism to achieve organizational goals related to quality and compliance
Lead a team of quality assurance and compliance professionals mentoring, fostering positive team culture, promote leadership growth, encourage innovation, and continuous learning to achieve team or individual goals
Identifying trend and areas of opportunity for process improvements and additional training
Work closely with operations leadership to review finding, develop action plans and remediate issues
Partner with operational leadership to review finding, develop corrective action plans, and remediate identified issues to the root cause ensuring a closed loop process
Monitor industry trends, regulatory changes and current events to ensure team remains informed and adapts to evolving policies and procedures

Requirements

What you’ll need

Bachelor’s Degree required
Graduate or Advanced Degree or equivalent experience preferred
Audit Certification preferred
5 years of related experience QA and compliance operations experience with Medicare and Medicaid across Operational areas
3+ years’ management experience in healthcare environment, preferably Medicare Advantage
8+ years of progressive experience in healthcare or health plan operations
Experience managing Quality Assurance and/or Operations Audit team
Experience working with AI or other machine learning tools to assist with streamlining QA processes
Deep experience in operational areas such as claims, configuration, provider data, benefits, enrollment, appeals and grievances
Proven success leading quality and compliance in a matrixed environment
Strong working knowledge of CMS and state regulations and operational implications

Benefits

Comp & perks

An annual employee bonus program
Robust Wellness Program
Generous paid-time-off (PTO)
Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday
Excellent 401(k) Retirement Saving Plan with employer match and contribution
Robust employee recognition program
Tuition reimbursement