Product Configuration Quality Analyst

Overview

What you can expect!

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Reporting to the Product System Configuration Supervisor, the Product Configuration Quality Analyst is responsible for ensuring the integrity of all claims system configuration created and maintained by the Product System Configuration team.

The Product Configuration Quality Analyst audits claims system configured by the Application Architects and Analysts to ensure accurate adjudication of claims. Ensure all Business Rules are configured correctly in the claims system. Support testing efforts within an agile team and execute all levels of testing (System, Data validation, Integration and Regression). The Product Configuration Quality Analyst utilizes quality auditing tools, identifies trainings needs, and collaborates on effective and efficient methods for accurate and quality system configuration.

Commitment to Quality:
The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

• Competitive salary
• State of the art fitness center on-site
• 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

• 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…