As a Professional Quality at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Gainwell empowers you to help clients deliver better health and human services outcomes using innovative technology and solutions, enabling you to design your career for growth, new possibilities, and refinement of your valuable skills. Here are the details on this position.
Your role in our mission
Identify, analyze, and document defects and inconsistencies in software program functions, outputs, online screens, and content, ensuring effects are corrected in a timely manner.
Utilize quality methodology to optimize delivery value; assess internal and external project successes, change requests and cost of change performance measures.
Implement and maintain a quality management process, including quality gates, lessons learned and other best practice activities.
Conduct quality management activities for projects to ensure adherence to quality, cost, and schedule parameters for the projects/programs and ensure project plans include sufficient quality management tasks, resources, and schedule impact.
Interface with the client, company, and project teams, measuring and communicating quality metrics and recommending changes as needed.
Monitor the delivery and utilization of covered services by Medi-Cal providers and members, and utilize pertinent data to detect unusual practices, billing anomalies, and potential abuse.
Analyze and evaluate the delivery and utilization of services on a case-by-case basis, making recommendations to guard against fraudulent or abusive use of services by either providers or members.
What we're looking for
Three (3) or more years of business analyst, quality assurance, engineering or audit experience required.
Experience working with quality metrics and software industry metric data collection and analysis techniques.
Experience working with quality assurance principles and practices.
Experience working with standard software development methodology assessments and software test science and tools.
Healthcare or insurance industry claims experience preferred.