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Quality Risk Specialist Jobs in California (NOW HIRING)

Softline Solutions

QA Specialist

Glendale, CA · On-site

$75K - $85K/yr

About the role We're looking for an QA Specialist to ensure the accuracy, reliability, and ... risk across lifecycle communications. What you'll do * Conduct comprehensive QA testing for ...

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Quality Risk Specialist information

What does a quality risk specialist do?

A Quality Risk Specialist is responsible for identifying, assessing, and mitigating risks that could impact product quality or compliance within an organization, particularly in regulated industries like pharmaceuticals or manufacturing. They develop risk management plans, perform risk assessments, and collaborate with cross-functional teams to ensure that quality standards are maintained throughout processes. Their work helps organizations meet regulatory requirements, improve operational efficiency, and prevent costly errors or product recalls.

What are the key skills and qualifications needed to thrive as a quality risk specialist?

To thrive as a Quality Risk Specialist, you need a solid background in quality management systems, risk assessment methodologies, and regulatory compliance, often supported by a relevant degree or industry certifications such as Six Sigma or ISO 9001. Familiarity with risk management software, audit tools, and documentation systems is commonly required. Strong analytical thinking, attention to detail, and effective communication skills help you identify potential risks and collaborate with cross-functional teams. These competencies are crucial for ensuring product and process quality, minimizing compliance issues, and safeguarding organizational reputation.

What are the main challenges a quality risk specialist faces when implementing risk management strategies across different departments?

A key challenge for Quality Risk Specialists is ensuring consistent risk management practices across various departments, each with unique processes and risk appetites. This often involves balancing regulatory compliance with operational efficiency, while also facilitating effective communication between teams like production, quality assurance, and regulatory affairs. Building strong cross-functional relationships and providing tailored training can help overcome resistance to new protocols and ensure everyone understands the value of robust risk management. Staying updated with evolving standards and adapting strategies accordingly is also essential for long-term success in this role.

What is the difference between Quality Risk Specialist vs Quality Assurance Specialist?

AspectQuality Risk SpecialistQuality Assurance Specialist
Required credentialsISO certifications, risk management trainingISO certifications, quality management training
Work environmentRegulatory, manufacturing, or healthcare settings focusing on risk assessmentManufacturing, labs, or service industries focusing on process compliance
Employer usagePharmaceuticals, biotech, medical devicesManufacturers, labs, service providers

While both roles focus on quality, the Quality Risk Specialist primarily assesses and mitigates risks to ensure product safety and compliance, whereas the Quality Assurance Specialist concentrates on maintaining quality standards and process adherence. Both roles are essential in regulated industries but differ in their core focus areas.

What cities in California are hiring for Quality Risk Specialist jobs?

Cities in California with the most Quality Risk Specialist job openings:

Infographic showing various Quality Risk Specialist job openings in California as of July 2026, with employment types broken down into 1% As Needed, 82% Full Time, 12% Part Time, and 5% Contract. Highlights an 85% Physical, 1% Hybrid, and 14% Remote job distribution.

Eligibility and Risk Specialist

Santa Clarita, CA • On-site

Shield Healthcare
201 - 500 employees
Learn more about Shield Healthcareexternal

$19 - $20/hr

Other

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 8 days ago

Job description

Eligibility And Risk Specialist

Since 1957, Shield Healthcare has provided high-quality healthcare services while focusing on customer satisfaction and employee achievement. We are dedicated to fulfilling the medical supply needs of consumers and the caregiving community while maintaining a 99% overall customer satisfaction rating. Over the years, Shield HealthCare has expanded nationally with current service locations in California, Colorado, Illinois, Ohio, Texas and Washington.

Shield HealthCare is looking for an Eligibility and Risk Specialist in Valencia, CA responsible for verifying eligibility and risk delegation for health plan members and properly maintaining customer records. Research related rejections and denials and make the necessary corrections to meet billing guidelines or recommend claims for write-off.

This position is on-site in Valencia, CA.

Job Responsibilities:
  • Responsible for verifying eligibility and risk delegation for health plan members and properly maintaining the customer records
  • Ensure that all eligibility verification requests are completed in a timely manner
  • Research problems and find solutions to eligibility related claim rejections and denials
  • Inform management of changes or trends with eligibility and risk issues
  • Research denials and billing requirements of third-party carriers utilizing web portals, phone contact, EOBs, provider manuals, etc.
  • Adjudicate claims issues by preparing and submitting corrected claims or appeals
  • Recommend claims for write-off when billing requirements are not met
  • Effectively communicate by phone, email, and in-person with third-party payers and internal staff to resolve eligibility issues and establish positive relationships
  • Accurately update and notate accounts receivable system, collections notepad, and customer accounts
  • Remain updated on company policies and procedures and third-party payer guidelines, bulletins, and billing requirements
  • Work reports and projects assigned by management
  • Ensure appropriate follow-up and timely completion of assignments
Qualifications:
  • Familiarity with various medical insurance payer guidelines/billing requirements preferred
  • Proficiency in Microsoft Office with experience working in Microsoft Excel
  • Must be detail oriented, thorough, accurate, and organized
  • Proven ability to research and solve problems
  • Good written and verbal communication skills
Pay & Benefits:
  • $19-20 / hour
  • Medical, Dental, and Vision
  • 401(k) with Company Match
  • Sick and Vacation Days
  • Flexible Spending Account
  • Life & Disability Insurance
  • Education Assistance
  • Employee Referral Program

Career-minded individuals will find our business challenging and our reputation for excellence just one of the rewards we have to offer. To further enhance this tradition of excellence, our employees participate in continuous training and development programs in a variety of disciplines.

The posted range for this position is $19-20/hour which is the expected starting base salary range for an employee who is new to the role to fully proficient in the role. Many factors go into determining employee pay withing the posted range including education, prior experience, training, current skills, certifications, location/labor market, internal equity, etc.

Shield Healthcare, Inc. is an Equal Employment Opportunity Employer and does not discriminate against applicants or employees on the basis of race, color, religion, creed, national origin, ancestry, disability that can be reasonably accommodated without undue hardship, sex, sexual orientation, gender identity, age, citizenship, marital or veteran status, or any other legally protected status.

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