SCAN

QA Engineer

• Responsible for developing and implementing a quality assurance program, reviewing audits meet accuracy, timeless and contractual obligations, and enhancing operational processes
• Partner with Operations leadership to design and develop an effective Quality Assurance and Compliance program gaining alignment on methodology, audit approach, KPIs, standards and issue resolution process
• Manage quality and Compliance reporting
• Coordinate accurate and timely submission of data, including audit readiness and documentation standards for Operations
• Collaborate with operational partners to align workflows, address barriers to performance, and implement initiatives to enhance operations and member satisfaction
• Monitor and communicate performance trends track and analyze key performance indicators (KPIs)
• Share actionable insights and recommendations with senior leadership to inform strategic planning and resource allocation
• Establish effective governance framework to include Audit the Auditor mechanism to achieve organizational goals related to quality and compliance
• Lead a team of quality assurance and compliance professionals mentoring, fostering positive team culture, promote leadership growth, encourage innovation, and continuous learning to achieve team or individual goals
• Identifying trend and areas of opportunity for process improvements and additional training
• Work closely with operations leadership to review finding, develop action plans and remediate issues
• Partner with operational leadership to review finding, develop corrective action plans, and remediate identified issues to the root cause ensuring a closed loop process
• Monitor industry trends, regulatory changes and current events to ensure team remains informed and adapts to evolving policies and procedures

Senior Manager, Quality Assurance and Compliance – Health Plan Operations

Business Operations

• Enable the re-design of Claims, Enrollment, Provider Data Management and Print & Fulfillment processes
• Facilitate workshops and meetings to map current state processes, gather feedback, and drive consensus to ideal state
• Identify inefficiencies, gaps and work arounds for improvement in current processes
• Facilitate the design and documentation of future-state processes and utilize future state to drive system design and requirements
• Support change management activities, including workstream communication, training, and stakeholder engagement.
• Monitor and report on project performance, including status, risks, opportunities to stakeholders; escalate risks that impact project’s critical path.

Senior Business Process Redesign Consultant

Actuary

• Prepare and analyze data for Part D and develop comparisons between actual versus forecast.
• Support ad-hoc analytics such as provider contracting, product development, and other customized projects to suit business needs.
• Utilize the Data Warehouse efficiently to develop reports and extract data fields.
• Analyze historical data trends in order to establish reasonable assumptions.
• Assist the actuarial team with the development of Medicare Advantage bid pricings by keeping track of various input parameters and testing benefit scenarios.
• Assist the financial budget and forecasts of pharmacy costs and the ongoing monitoring of actual results.
• Proactively identify opportunities to streamline workflows, enhance model efficiency, and improve automation of existing processes.
• Bring intellectual curiosity and a continuous improvement mindset to all assigned work, challenging the status quo where appropriate.

Actuarial Analyst – Health Plan

General

• Provide strategic guidance and support to the Configuration Department
• Oversee the end-to-end planning, development, testing, and implementation of system configuration changes
• Lead the design, development, debugging, testing, maintenance, and enhancement of automated processes in collaboration with IT partners
• Identify opportunities for system redesign and enhancements

Senior Configuration Specialist, QNXT

• Lead business-side execution for core admin transformation across all operational domains, serving as the primary point of coordination between business leaders, IT, and system integrators
• Drive integrated business planning, milestone tracking, dependencies, and readiness activities across enrollment, billing, claims, provider, finance, and shared services.
• Partner with operational leaders to translate future‑state processes into clear requirements, design decisions, and adoption plans; avoid “lift-and-shift” approaches.
• Manage cross‑functional risks, issues, and decisions; escalate when needed with clear options and recommendations.
• Drive business readiness activities including change management, training coordination, cutover planning, parallel runs, and post‑go‑live stabilization.
• Provide clear executive‑level updates on progress, risks, and readiness across business workstreams.
• Work in close collaboration with Program PMO to manage milestones, dependencies, risks, and critical path business deliverables.

Program Principal, Business Operations – SCAN

Payroll

• Oversee payroll tax compliance for a multi-state, multi-company environment.
• Ensure adherence to federal, state, and local regulations.
• Serve as the primary liaison with ADP Tax Services to ensure service accuracy and compliance.
• Work with ADP to set up new tax jurisdictions.
• Review tax notices and coordinate with ADP for resolution, including root cause analysis and prevention.
• Validate periodic, quarterly and annual tax filings prepared by ADP Tax Services including 940, 941 & W-2s.
• Maintain relationships with tax agencies and ensure timely responses.
• Act as a subject matter expert for payroll tax configuration within Workday.
• Perform payroll tax reconciliations between Workday, ADP Tax Services, and final tax filings.
• Prepare and review payroll tax journal entries and support financial close processes.
• Investigate and resolve discrepancies related to tax liabilities, filings, and payments.
• Research and update accounting team related to payroll tax and payment services banking items.
• Support audits by providing payroll tax documentation and reconciliations.
• Support the interim and year-end financial audit process as well as annual company tax filings (990;4720).
• Serve as a resource and a back-up for payroll department functions.
• Partner with Payroll, HR, Benefits, and accounting teams.
• Provide guidance on taxation of benefits and special pay scenarios.
• Crosstrain payroll team members on tax compliance.
• Maintain documentation of payroll tax procedures and workflows.
• Identify inefficiencies and recommend process improvements and automation including AI recommendations.
• Develop payroll & tax reporting metrics and dashboards to monitor compliance and trends.
• Maintain professional and technical knowledge by attending education workshops.
• Ensure compliance with internal controls and organizational policies.

Senior Payroll Tax Analyst

Business Analyst

• Acts as subject matter expert and liaison to IT and business stakeholders
• Analyzes, communicates, and validates requirements for changes to business processes, policies and information systems
• Develops functional specifications, change requests, workflows and business processes for complex business engagements
• Ensures issues are identified, tracked, reported and resolved in a timely manner
• Communicates needed changes to development team
• Reviews and edits requirements, specifications, and recommendations for process optimization
• Monitors and audits processes providing support during compliance audits
• Manages milestones and deliverables for complex business and systems projects

Senior Business Analyst – SCAN Temp

Network Engineer

• Coordinate end-to-end provider onboarding and offboarding management: Project manage all cross-functional tasks and deliverables associated with the provider onboarding, including pre-delegation audits, roster loading and display, MFT setup, claims payment configuration, and reporting activation to ensure seamless onboarding experiences.
• Manage provider offboarding processes: Ensure smooth offboarding when a provider terminates or changes MSO affiliation by coordinating member reassignment, provider data removal, report deactivation, and compliant member communication in partnership with internal teams.
• Develop and maintain workflows and documentation: Design, implement, and regularly update standardized workflows, procedures, and timelines to support consistent practices, operational readiness, and data integrity throughout the full provider lifecycle.
• Ensure clear operational handoffs across departments and adherence to established timelines for onboarding and offboarding activities.
• Collaborate with Network Training and Compliance teams: Partner with the Network Training Specialist for all education and training needs, and work with the Compliance team to confirm all policies, desktop procedures, and materials associated to provider onboarding and offboarding comply with regulatory and organizational standards.
• Monitor project milestones and risk management: Track and analyze project deliverables, identify risks or process gaps, and coordinate timely resolutions with business partners to maintain accuracy and efficiency across operational readiness for provider onboarding and offboarding.
• Serve as subject matter expert and liaison: Represent Network Management in cross-functional meetings and governance committees related to provider onboarding and offboarding, providing insight and expertise on provider implementation, configuration readiness, and operational optimization.
• Ensure regulatory and audit readiness: Promote compliance and adherence to CMS, DMHC, DHCS, and NCQA requirements through accurate documentation, lifecycle tracking, and post-termination data closure activities to maintain audit preparedness and meet quality standards.
• Facilitate provider communications, education, and presentations: Collaborate with Network Training and Communications teams to enhance provider onboarding materials, orientation tools, and outreach initiatives enhancing provider understanding and engagement.
• Conduct provider presentations and engage directly with provider partners to ensure clarity around onboarding expectations, operational workflows, and ongoing requirements.
• Drive continuous process improvement: Identify and implement enhancements to workflows, tools, templates, and reporting processes that increase efficiency, accuracy, and provider satisfaction throughout the lifecycle.
• Support system modernization and integration efforts: Contribute to SCAN’s system improvement and migration projects by capturing business requirements, testing enhancements, validating changes, and supporting implementation during and after release.

Network Management Implementation Specialist

Account Executive

• Assess health plan needs of prospective members, verify Medicare / Medi-Cal eligibility, and facilitate telephonic enrollment.
• Schedule sales appointments and/or schedule seminar reservations attendance as needed.
• Facilitate Telephonic enrollment(s) by presenting benefit information over the phone and assisting prospects with completing the enrollment process.
• Follow all state and regulatory guidelines by adhering to programs implemented by CMS (Centers for Medicaid and Medicare Services).
• Demonstrate and maintain knowledge of Medicare, Medi-Cal and SCAN benefits by successfully completing required trainings.
• Support Field Sales Representatives by assigning in-home appointments and setting reservations to seminar sales presentation meetings and/or other sales events.
• Complete the 30/60/90 Days Welcome Calls.
• Adhere to required follow-up goals.

Telesales Representative

Bilingual

• Enhance frail seniors' ability to age in place, manage their health, navigate the health care system, and live independently by providing person-centered care in accordance with ECM requirements.
• Collaborate in conducting general assessments to identify chronic conditions and psychosocial challenges affecting independent living.
• Perform assessments for Medi-Cal/Medicare dual-eligible members referred to Complex Care Management for Long-Term Services and Supports (LTSS) and assist the Registered Nurse in determining Nursing Facility Level of Care.
• Support member well-being through observation, positive communication, and motivational interviewing.
• Conduct face-to-face or phone visits to address care barriers, ensure engagement in primary and preventative care, and support individualized care plan implementation.
• Provides general care coordination and empower members and their families in managing chronic conditions through coaching, education, healthcare navigation, advocacy, accompaniment to appointments and referrals to community, county, and state resources.
• Perform Enhanced Care Management (ECM) activities related to specific Populations of Focus (POF): Individuals Experiencing Homelessness, Individuals At Risk for Avoidable Hospital Or ED Utilization, Adults Living In the Community At Risk of LTC Institutionalization, Adult Nursing Facility Residents Transitioning Back to the Community.
• Implement personalized care plans tailored to the medical and social needs of high-risk members, incorporating realistic health goals supporting members inherent wishes.
• Actively participates in interdisciplinary planning and case conference meetings to ensure person-centered care and to ensure member receives support following discharge from an inpatient or institutional setting.
• Demonstrates strong organizational, follow-through, and engagement skills to achieve positive member outcomes.
• Adheres to SNP policies and ensures timely, accurate documentation of care plans, service plans, and progress notes within established timeframes.
• Network and build relationships with community business organizations like senior and wellness centers, housing outreach events, shelters, landlords, legal aid providers, etc.
• Utilizes department desktop procedures, workflows, job aids and training material.
• Identifies barriers to work processes and brings to the attention of the supervisor/manager.
• Performs work under direct supervision.
• Handles basic issues and problems and refers more complex issues to higher-level staff.
• Possesses beginning-to-working knowledge of subject matter.

Bilingual Spanish Community Health Worker

• Responsible for helping SCAN prospects and members identify health plan options to keep them healthy and independent
• Initiate and generate opportunities for sales presentations, group meetings, community events and other senior activities within assigned service area
• Establish and maintain productive relationships with providers and community leaders
• Generate and develop sales leads and create a book of business
• Enter leads into company CRM
• Develop sales resources and create a network of opportunities and contacts
• Promote member retention by resolving inquiries and proactively communicating with current members frequently within assigned marketing area
• Adhere to production goals and performance standards
• Create comprehensive reports that provide production data and measure results of growth objectives
• Maintain professional and technical knowledge by attending educational workshops
• Meet with leadership to review performance metrics, determine sales strategies, and enhance sales techniques and processes
• Follow all state and regulatory guidelines by adhering to sales and marketing requirements established by CMS, MIPPA and other policies and procedures implemented by Compliance Department
• Contribute to team effort by accomplishing related results as needed

Health Insurance Sales Representative – Vietnamese, Korean

Business Development Rep

• Partner with all sales leaders across all sales channels to ensure a continual pipeline to meet assigned sales/membership growth targets
• Build and strengthen relationships within the local community to include local politicians, senior centers, providers, and other centers of influence
• Coordinate community meetings and events in local markets
• Representing at community/employer/company-sponsored events to promote the company, raise awareness, and generate leads and resulting sales
• Maintaining consistent and effective communication with external stakeholders, elected officials, county and community-based programs and any growth opportunities
• Achieve assigned sales/membership growth targets
• Tracking lead and sales conversions
• Develop, implement, and monitor plans focused on lead generation
• Generating qualified leads that convert into members
• Help build and advance our brand and value propositions
• Analyzes major competitor strategies
• Identifies and monitors changing patterns of competition and recommends responses
• Creates business cases and/or obtains resources (people, funding, material, support) business information needs and strategic initiatives
• Adhering to the highest level of compliance expectations
• Meeting expected use of the customer relationship management system
• Adhering to all sales operations processes
• Knowing all elements of the product portfolio and associated eligibility guidelines for various election periods

Community Business Development Manager, NorCal / Washington

• Provide long-term care management to frail, economically disadvantaged, culturally diverse older adults, disabled adults and caregivers
• Assess new clients and determine appropriateness for the MSSP program, certify nursing home eligibility
• Conduct assessments and reassessments for identification of client’s medical, physical, and psychological needs
• Ensure client’s needs are met through written care plan approved by the program supervisor
• Provide ongoing health education to non-clinical staff members
• Present cases at weekly team case conferences
• Discuss during case conference complex health care issues for teaching purposes
• Maintain monthly documentation of clients and clinical documentation of relevant contacts in a timely manner
• Develop and implement care plans for assigned caseload
• Participate regularly in Quality Assurance chart reviews

Bilingual Korean Nurse Care Planner – RN

Sales Operations Manager

• Ensure accuracy of commission payments by auditing data, resolving discrepancies and enforcing compensation rules.
• Analyze compensation trends and provide actionable insights on sales performance
• Maintain and enhance commission systems, tools and workflows to improve efficiency, scalability, and transparency
• Respond to sales inquiries regarding commission payments and provide clear explanations of compensation calculations
• Drive continuous improvement initiatives to simplify processes, reduce errors, and enhance user experience

Senior Manager, Quality Assurance and Compliance – Health Plan Operations

Senior Business Process Redesign Consultant

Actuarial Analyst – Health Plan

Senior Configuration Specialist, QNXT

Program Principal, Business Operations – SCAN

Senior Payroll Tax Analyst

Senior Business Analyst – SCAN Temp

Network Management Implementation Specialist

Telesales Representative

Bilingual Spanish Community Health Worker

Health Insurance Sales Representative – Vietnamese, Korean

Community Business Development Manager, NorCal / Washington

Bilingual Korean Nurse Care Planner – RN

Senior Sales Operations Analyst

Actuarial Analyst – Health Plan