SCAN

Operations

• Ensure regulatory compliance with respect to prescription benefits set up and year-round CMS Program Audit, 1/3 Financial audit, National MEDIC, and other audits readiness;
• Provide leadership and support during all CMS Regulatory Audits related to pharmacy operations;
• Ensure accuracy of written responses and/or documentation for the pharmacy audits;
• Prepare written responses or documentation for pharmacy audits.
• Serve as a subject matter expert for Part D Reporting requirements.
• Maintain current knowledge of Medicare Part D regulations by participating in CMS calls and reading released guidance.
• Oversee the accurate implementation and maintenance of pharmacy benefits.
• Lead automation efforts related to the Prescription Drug Event, Benefits Configuration and Testing Initiatives.
• Prepare documentation for Service Area Expansion application submission to CMS.
• Collaborate with other SCAN departments by participating in cross-functional meetings.

Manager, Pharmacy Operations

Data Analyst

• Conducts monthly and quarterly financial reconciliations, reviewing account activity and resolving discrepancies to maintain accurate financial records.
• Reconciles data across financial, billing, and operational systems to ensure completeness, consistency, and alignment of key datasets.
• Maintains and enhances the billing module by updating logic, troubleshooting issues, and supporting automation using Alteryx, SQL, and advanced Excel/VBA.
• Completes daily and monthly cash reconciliations by matching bank activity to system postings and resolving unapplied or unidentified payments.
• Performs detailed revenue reconciliations, validating billed, recognized, and collected revenue and supporting month-end close activities.
• Monitors data quality across financial processes by implementing reconciliation controls, documenting workflows, and ensuring audit readiness.
• Collaborates with Finance, RCM, IT, and Operations to resolve issues, validate system changes, and improve end-to-end financial and billing workflows.

Accounting Data Analyst

Customer Support

• Serves members by being an advocate and point of contact for member questions and concerns regarding benefits, eligibility, referrals, claims and any other aspects of plan benefits and services
• Ensures member satisfaction by providing superior customer service and willingness to help at all time while maintaining a professional demeanor
• Provides quality customer service by apply SCAN Five Service Principles
• Educates members, family, providers and caregivers regarding benefits and plan options
• Accurately explains benefits and plan options in person, via email or telephonically
• Provides follow-up with members by clarifying the customer’s issue, determining the cause, and identifying and explaining the solution
• Escalates appropriate member issues to management or other departments as required
• Consistently meets and/or exceeds the departmental standards, including, but not limited to: quality, productivity, and adherence to schedule and attendance
• Responds appropriately and in a timely fashion to member/internal staff/providers by answering telephonic and written inquiries concerning benefits, eligibility, referrals, claims and all other issues following departmental policies and procedures and job aids
• Takes ownership of the issue, focusing on providing solutions and options for members, as necessary through resolution of member issue
• Increases member satisfaction by following up and resolving member issues, complaints, and questions in an efficient, timely and accurate fashion; coordinates resolution with providers and other departments as needed
• Participates in member calling projects as assigned by management to support the overall SCAN goal of membership retention
• Follows policies and procedures and job aids in order to maintain efficient and complaint operations; communicates suggestions for improvement and efficiencies to management; identifies and reports problems with workflows following proper departmental procedures; actively participates in departmental staff meetings and training sessions
• Follows all appropriate Federal and State regulatory requirements and guidelines applicable to Scan Health Plan operations, as documented in company policies and procedures
• Follows all HIPAA requirements
• Documents transactions by completing applicable member forms and summarizing actions taken in appropriate computer system and following standards set by the department or by other authorized individuals
• Temporarily responds to routine member questions and concerns on specific medical group call queues as part of skill development
• Contributes to team effort by accomplishing related results as needed

Customer Service Representative, Bilingual

• Patient engagement & access leadership
• Optimize, monitor, and actively manage the end-to-end patient engagement and access funnel
• Optimize coordination and workflows around referrals from risk-bearing entities (RBEs)
• Lead call center operations, ensuring strong performance management, effective workflows, and appropriate technology utilization
• Capacity planning & scheduling operations
• Optimize provider scheduling and routing logistics to balance provider capacity with patient demand
• Maximize provider utilization while sustaining patient and provider experience and satisfaction
• Work with the executive team to inform decisions around geographic expansion, hiring, provider compensation, and incentives
• Partner with Product and IT teams on scheduling technology improvements
• Support the Manager of Patient Engagement on escalated issues and capacity constraints
• Monitor and manage performance against service level agreements (SLAs)
• Oversee, coach, and lead account managers for key partners
• Monitor performance, report outcomes to partners, and drive mutual accountability on SLAs and contract performance
• Manage operational KPIs, including setting targets and holding teams accountable for performance
• Identify opportunities and lead process improvement initiatives
• Coordinate with the Clinical Operations Leader to manage provider capacity, performance expectations, and clinical workflows
• Support the President and VP of Commercial Strategy & Product Innovation to ensure a positive customer experience and optimized workflows
• Manage direct reports and provide coaching to support effective team leadership, goal-setting, feedback, and performance reviews

VP, Operations

Bilingual

• The Concierge Advocate serves as a direct point of contact for members’ questions and concerns
• He or she is responsible for taking member calls, as well as making proactive calls, as needed
• The Concierge Advocate is a liaison between the member and SCAN’s internal and external stakeholders, advocating for and representing the member as needed to resolve issues and concerns
• Front line contact center agent that is responsible for answering our member’s questions as they come in through inbound calls
• Manage and support a specific group of members
• Ensure that their members’ issues/questions/concerns are being addressed across the entire SCAN internal and external value chain with timely and effective resolution
• Drive SCAN’s Concierge customer service philosophy and ensure timely resolution of healthcare administrative issues/questions
• Assist the team leads in managing their membership
• Document interactions with members to update member’s records and help track issue resolution
• Participate in team huddles to discuss common member issues/trends and the path to resolution

Member Services Advocate – Bilingual

Clinical Operations

• Oversee and optimize daily operations within clinical pods
• Implement and maintain the infrastructure that supports daily POD operations
• Collaborate with central operations project teams to identify standardization opportunities
• Design, implement, and manage new healthcare initiatives and programs
• Monitor and analyze POD performance metrics
• Conduct regular touchpoints with the APC manager and Medical Director
• Perform in-person rounding at POD communities
• Recruit, on-board, manage, and coach the team supporting clinicians
• Develop, update, and audit POD operations workflows

Manager, Clinical Operations

QA Engineer

• Ensures compliance with regulatory and company/departmental standards by monitoring staff and processes, and implementing corrective action, as required.
• Improves service quality and efficiencies by developing and implementing standards, workflows and processes that are compliant with regulatory requirements and supports the delivery of service excellence.
• Maintain regulatory compliance by remaining knowledgeable of regulations and contractual requirements related to customer service operations, developing and implementing processes and policies/procedures that meet or exceed requirements.
• Ensure the SCAN commitment of service excellence to our customers by ensuring that staff consistently provide a level of service that meets or exceeds the customer’s expectation while being respectful, kind and knowledgeable about SCAN benefits and services.
• Identify and remediate deficient practices/processes by monitoring processes and staff interactions with customers, providing feedback, identifying trends and overseeing and measuring corrective actions.
• Provide management with feedback on staff performance and participate in coaching of the staff.
• Improve service quality by measuring the quality, effectiveness and efficiency of the customer experience and provide recommendations for improvement to management.
• Support the Member Services Trainer by providing feedback on training needs and assist in the development and presentation of training, as required.
• Maintain awareness of membership and service issues by generating reports, analyzing data to identify trends, and making recommendations for improvement.
• Contribute to team effort by accomplishing related results, as needed.
• Actively support the achievement of SCAN’s Vision and Goals.
• Other duties as assigned.

Quality Assurance

• Ensures compliance with regulatory and company/departmental standards by monitoring staff and processes, and implementing corrective action, as required.
• Improves service quality and efficiencies by developing and implementing standards, workflows and processes that are compliant with regulatory requirements and supports the delivery of service excellence.
• Maintain regulatory compliance by remaining knowledgeable of regulations and contractual requirements related to customer service operations, developing and implementing processes and policies/procedures that meet or exceed requirements.
• Ensure the SCAN commitment of service excellence to our customers by ensuring that staff consistently provide a level of service that meets or exceeds the customer’s expectation while being respectful, kind and knowledgeable about SCAN benefits and services.
• Identify and remediate deficient practices/processes by monitoring processes and staff interactions with customers, providing feedback, identifying trends and overseeing and measuring corrective actions.
• Provide management with feedback on staff performance and participate in coaching of the staff.
• Improve service quality by measuring the quality, effectiveness and efficiency of the customer experience and provide recommendations for improvement to management.
• Support the Member Services Trainer by providing feedback on training needs and assist in the development and presentation of training, as required.
• Maintain awareness of membership and service issues by generating reports, analyzing data to identify trends, and making recommendations for improvement.
• Contribute to team effort by accomplishing related results, as needed.
• Actively support the achievement of SCAN’s Vision and Goals.

Quality Assurance Specialist

Accounting Data Analyst – Agency Temp

Analyst

• Forecasting and capacity planning will incorporate contact center channels (i.e., voice/phone, secure message, unsecure email, text, etc.) and other activities (i.e., research, follow-up, etc.).
• Work output to include gap analysis.
• Capacity planning to organizational objectives.
• The desired reporting and analysis will be generated for prior month, current month, and long-term forecasts which will be utilized in a monthly cross-departmental meeting to determine budget and resources.
• Facilitate additional communication and reporting with stakeholders, ensuring transparency and alignment across teams.
• Forecasting and capacity planning will be continually prepared refined to adjust modeling based upon inputs and historical data.
• Model and visualize complex scenarios to inform strategic decision-making and ensure optimal resource allocation.
• Utilize Aspect software in combination with other resources to generate ongoing forecasting and capacity planning for internal customer departments.
• Promote continuous improvement for role and the workforce management team.
• Interact with Aspect software and other tools to update information to drive forecasting and capacity planning.
• Work with internal customers to stay current with inputs that will impact forecasting and capacity planning.

Senior Workforce Analyst

• Support members that are at risk for specific health conditions to manage their own health. • Make outbound calls to SCAN members based on identified health interventions or quality initiatives. • Build rapport with members by communicating personal experiences as a SCAN member and peer to enhance the effectiveness of health education and increase likelihood of positive behavior change. • Coach members to create and implement strategies that minimize risks associated with the identified common health conditions. • Encourage and provide assistance to members who may encounter obstacles to seeking care. • Document all required information in the care management system during phone calls with members. • Maintain client confidence by keeping information confidential. • Utilize department job aids and training materials.

Peer Advocate, Bilingual

Compliance

• Ensure all company operations and services meet the highest standards of quality and compliance
• Lead and coordinate quality projects, ensuring they are completed on time and within budget
• Identify issues and develop solutions to keep the project on track
• Collaborate with other departments to ensure seamless integration of quality and compliance initiatives
• Generate and present comprehensive reports on quality performance
• Develop and deliver training programs to educate employees on quality standards

Senior Quality and Compliance Coordinator

Business Analyst

• Drive Payment Integrity cost savings across multiple programs with an expected impact over $10 million in 2026
• Create reports/dashboards that track payment integrity metrics over time
• Develop payment integrity and capitation Reporting models to tailor interventions and communications
• Identify pain points across the payment integrity and capitation reporting, journey
• Support our Payment Integrity team to identify key insights
• Analyze and build BI around payment integrity metrics
• Write complex SQL queries to extract payment integrity data from the enterprise data warehouse
• Support or help build personalization engines for payment integrity

Senior Business Analyst – Configuration, Payment Integrity

Program Manager

• Executes programs that meet the needs of the organization or its employees or customers.
• Participates in all aspects of corporate programs, including planning, budgeting, staffing, and performance.
• Promotes the program throughout the organization and tracks utilization.
• Supervises the work of program or project staff to ensure that work in completed on time or in accordance with established standards or specifications.
• Evaluates program effectiveness by collecting and analyzing data in support of key performance metrics.
• Ensures that activities are in compliance with organizational policies and any relevant external regulations.
• Provides reports and updates to senior management or other stakeholders.
• Serves as leader of authority with expert-level knowledge in one or more areas.
• Makes authoritative decisions and recommendations.
• Plans, organizes, and guides projects and subordinate employees.
• Responsible for defining the vision, scope, and objectives of program and encompass multiple related projects.
• Develop comprehensive program roadmaps, manage budgets, allocate resources, and oversee timelines.
• Maintain communications between stakeholders, sponsors, and team members.

Senior Program Manager

Cloud Engineer

• Design the foundation that makes intelligent systems scale for our enterprise
• Define and govern the architecture that powers SCAN’s AI and automation capabilities
• Bridge infrastructure and innovation, ensuring every AI and cloud solution is built on secure, performant, and reusable patterns
• Bring a holistic view to enable experimentation while maintaining enterprise standards for reliability, governance, and compliance
• Define the end-to-end reference architecture for AI and data/storage systems across Azure AI Foundry, Azure AI Services, Azure AI Search, Azure Databricks/Fabric, and Snowflake
• Design integration blueprints for RAG workflows, data pipelines, agentic frameworks, and enterprise GPT solution
• Establish standards for model deployment, versioning, prompt management, and telemetry within Azure AI Foundry
• Build and maintain scalable cloud environments for model training, evaluation, and inference
• Oversee vector database design (Azure AI Search or equivalent) and integration with Snowflake/Fabric data hubs
• Partner with IT Security to ensure alignment with HIPAA, Responsible AI, and internal compliance requirements
• Design pipelines and event-driven architectures using Azure Functions, Logic Apps, and API Management
• Automate ingestion and evaluation processes for Document Intelligence, AI Search, and other Azure AI Services
• Integrate monitoring, audit, and feedback loops to ensure operational transparency and continuous improvement
• Lead architecture reviews and guide solution teams to adhere to Responsible AI and data-management standards
• Define metadata, lineage, and model registry conventions for consistent tracking and reuse
• Collaborate with engineering, analytics, and business teams to align technical designs with strategic outcomes
• Serve as a key contributor to the AI Architecture Review Board and cloud optimization initiatives
• Evaluate emerging Azure and open-source technologies to extend SCAN’s AI capabilities
• Prototype new integration patterns for multi-agent collaboration, knowledge management, and semantic data discovery
• Coach engineers on architectural best practices and help shape the long-term technical roadmap