Quality Assurance Compliance Analyst

Gainwell Technologies

. Conduct quality reviews and audits of healthcare claims and operational processes .

Posted 9/21/2026full-timeWest Sacramento • California • United StatesMid-LevelSenior💰 $53,900 - $77,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in quality assurance and compliance within healthcare operations, with a strong focus on claims analysis, auditing processes, and regulatory adherence. Proficient in identifying trends and implementing process improvements to enhance operational efficiency and quality metrics.

Highest-signal resume keywords

Quality AssuranceHealthcare Claims AdjudicationRoot-Cause AnalysisRegulatory ComplianceData Analysis

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ValidationAuditingQuality DocumentationProcess ImprovementCoding Error IdentificationTrend AnalysisCompliance RequirementsHealthcare OperationsQuality Metrics AnalysisDenials and Appeals Management

Soft Skills

Analytical SkillsProblem-SolvingOrganizational SkillsCommunication SkillsAttention to Detail

Tools & Technologies

EDMSNICE CXoneMMIS

Industry Keywords

Medi-CalMedicaidDHCSHealthcare ComplianceQuality Improvement Initiatives

About the role

Key responsibilities & impact

Conduct quality reviews and audits of healthcare claims and operational processes
Evaluate accuracy, completeness, and compliance with policies, procedures, and regulatory requirements
Analyze claims data to identify trends, anomalies, coding errors, quality issues, and improvement opportunities
Review claims, denials, appeals, provider enrollment, and related operational activities
Validate data accuracy and identify potential compliance or quality concerns
Document audit findings and maintain appropriate audit trails
Analyze quality metrics and communicate findings to operational and non-technical stakeholders
Participate in root-cause analysis and recommend corrective actions and process improvements
Support compliance and regulatory reporting, internal and external audits, and quality improvement initiatives
Partner with claims, clinical, compliance, and operational teams for the Medi-Cal account

Requirements

What you’ll need

High school diploma or GED required; bachelor’s degree or equivalent professional experience preferred
Three or more years of experience in quality assurance, compliance, auditing, healthcare operations, claims, or a related field
Experience with healthcare claims adjudication, claims validation, denials, appeals, billing, or related healthcare operational processes
Knowledge of common claims quality issues, coding errors, and healthcare quality or compliance requirements
Familiarity with Medicaid or Medi-Cal operations and regulatory requirements, including DHCS or other applicable state regulatory or accreditation requirements, preferred
Experience analyzing data, identifying trends, conducting root-cause analysis, and supporting process improvement initiatives
Experience maintaining quality documentation, audit findings, and audit trails
Knowledge of systems such as EDMS, NICE CXone, or MMIS is a plus
Strong analytical, problem-solving, organizational, and communication skills with excellent attention to detail
Candidates must reside in California and be able to report to the West Sacramento office as needed
Travel requirements of approximately 0–10%
Video cameras must be used during all interviews

Benefits

Comp & perks

Work flexibility
Learning and career development
Generous, flexible vacation policy
401(k) employer match
Comprehensive health benefits
Educational assistance
Leadership and technical development academies
Travel expense reimbursement and other benefits as applicable