Director, Center of Excellence and Quality Assurance

Salary Range: $ (Min.) - $ (Mid.) - $ (Max.)

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

The Director, Center of Excellence & Quality Assurance is responsible for leading the quality, compliance, training, and continuous improvement functions that ensure L.A. Care’s Core Administrative Operations ecosystem operates with accuracy, integrity, and regulatory readiness. This role builds a disciplined quality framework that strengthens upstream and downstream controls, enhances first-pass accuracy, reduces defects, and ensures consistent, predictable outcomes across Claims Administration, Configuration, Payment Integrity, and related operational areas.

The Director oversees enterprise claims quality auditing, claims compliance oversight, issue detection and validation, corrective action planning, root-cause analysis, and enterprise reporting on quality performance. This role oversees enterprise quality for both operational claims processing and system configuration, ensuring the accuracy of benefit builds, provider reimbursement logic, system edits, pricing methodologies, and operational rules prior to deployment and ensures the organization meets federal, state, and contractual requirements by maintaining effective monitoring, quality review programs, compliance validation, and documentation standards.

The Director also leads training and policy interpretation for claims-related operations, ensuring teams have the knowledge, tools, and guidance needed to maintain accuracy and adhere to changing regulatory requirements.

The Director creates a disciplined quality framework that strengthens upstream and downstream controls, enhances first-pass accuracy, reduces defects introduced through system changes, and ensures consistent execution across Core Administrative Operations service lines. The Director serves as the primary partner to operational leaders on quality and compliance matters, providing subject matter expertise on regulatory interpretation, operational risk, quality trends, and systemic improvements.

This position builds a high-performing team and fosters a culture of quality, operational rigor, accountability, and continuous improvement.

This position is responsible for directing all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports. Develops strategic plans, drives change and influences critical business outcomes.

Strengthens L.A. Care’s operational quality by creating a structured, disciplined approach to auditing, compliance, and process validation. Ensures quality is proactively managed, system and process changes are controlled, and risks are quickly identified and remediated. Through cross-functional collaboration, transparent reporting, and strong execution, that improves operational maturity, enhances accuracy, reduces rework, and supports sustainable performance across all core administrative operations.

Leads the continuous improvement and execution of the Core Administrative Operations quality audit program, including audit planning, sampling methodologies, examiner scorecards, and real-time quality monitoring, managing both examiner-level QA and configuration build validation. Ensures quality review processes measure end-to-end claims accuracy, including benefit interpretation, provider contract application, coding, pricing, and system logic. Oversees testing and validation of configuration changes, including benefit builds, reimbursement tables, pricing logic, clinical/non-clinical edits, and system enhancements.

Ensures robust pre-production testing (unit, peer,…