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SCAN
SCAN
1,001 – 5,000 Employees
H1B Visa SponsorB2CHealthcareHealthcare Insurance
SCAN is a mission-driven healthcare organization dedicated to helping older adults live healthier, more independent lives. Founded in 1977, it combines healthcare insurance with evidence-based, patient-centered services, including in-home and virtual primary care, caregiver support, programs for homebound adults, and specialized care for vulnerable populations. SCAN also partners with and invests in organizations developing new care models and resources for aging at home.
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Healthcare Configuration Analyst II - Hybrid in Long Beach

Maintain SCAN Health Plan’s healthcare benefit and authorization code systems. Support configuration, data analysis, testing, compliance, and operational improvement initiatives.

USUnited StatesCACalifornia
$71,700 – $103,732 / year
HybridFull-timeJuniorMiddleEnglish RequiredAnalyst
SQL

Description

  • Support the implementation, maintenance, and governance of SCAN Health Plan’s benefit configuration, including Prior Authorization (PA) and Pre-Determination (PD) code sets
  • Maintain PA and PD code sets across claims, utilization management, and related operational systems
  • Handle benefit configuration and prior authorization work through configuration, testing, validation, deployment, and post-implementation review
  • Act as a technical liaison for PA and PD configuration with internal teams, delegated entities, providers, and vendors
  • Investigate and resolve benefits and authorization configuration issues, technical questions, and system problems affecting operations
  • Prepare for the Annual Enrollment Period by completing assigned configuration work, validating accuracy, and meeting implementation deadlines
  • Evaluate data to uncover trends, risks, improvement opportunities, and operational or financial effects
  • Advance continuous improvement by strengthening workflows, reporting, data quality, system functionality, and operational efficiency
  • Develop and update procedures, workflow documentation, training materials, and other resources for PA and PD list operations
  • Stay current on healthcare coding standards, authorization processes, CMS regulations, healthcare technology, and related practices
  • Contribute to SCAN’s vision and goals
  • Complete other assigned responsibilities

Requirements

  • Bachelor’s degree or equivalent experience in healthcare administration, health information management, information systems, data analytics, business, computer science, or a related field
  • At least two years of experience in healthcare systems, operations, analytics, medical coding, utilization management, or related technical work
  • At least two years of experience with reporting, data analysis, SQL, or healthcare data
  • Experience with healthcare coding systems, code-set maintenance, or authorization processes
  • Knowledge of healthcare coding systems, including CPT®, HCPCS, and related code sets
  • Understanding of healthcare claims processing, utilization management, authorization workflows, and healthcare operations
  • Knowledge of CMS regulations and Medicare Advantage and Medicaid program requirements is preferred
  • Strong analytical and problem-solving abilities, including data interpretation, issue detection, root-cause analysis, and solution development
  • Proficiency in data analysis, reporting, performance measurement, SQL, reporting tools, and business intelligence platforms is preferred
  • QNXT experience is required
  • Proficiency with Microsoft Office Suite and related productivity applications
  • Excellent written and verbal communication skills, with the ability to explain technical concepts to technical and non-technical audiences
  • Strong organization, attention to detail, and ability to manage competing priorities and deadlines
  • Ability to work independently while collaborating with multidisciplinary teams
  • Commitment to accuracy, quality, compliance, continuous improvement, and standard office-based work involving computers and office equipment for extended periods
  • Experience managing Prior Authorization or Pre-Determination Lists is preferred
  • Experience with Medicare Advantage and/or Medicaid managed care programs is preferred
  • Experience supporting healthcare claims, utilization management, or medical policy operations is preferred
  • Experience with business intelligence tools such as Power BI is preferred
  • Familiarity with healthcare vendor platforms such as MHK, ikaSystems, CareAxis, or similar applications is preferred
  • Experience using AI-enabled analytical tools and automation technologies is preferred
  • Coursework or training in healthcare analytics, healthcare informatics, business intelligence, or database management is preferred
  • Certification or coursework in SQL and Power BI is preferred
  • Certification in healthcare analytics, data visualization, business intelligence, or a related technical discipline is preferred
  • Background check required

Benefits

  • Annual employee bonus program
  • Comprehensive wellness program
  • Generous paid time off (PTO)
  • Eleven paid holidays annually, plus one floating holiday and one birthday holiday
  • 401(k) retirement savings plan with employer match and contribution
  • Employee recognition program
  • Tuition reimbursement
  • Mostly remote work arrangement
  • Equal pay, employee resource groups, inclusive benefits, and more

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