SCAN

Bilingual

• Provide long-term care management to older and disabled adults
• Conduct in home and telephonic assessments, care planning, and client monitoring
• Coordinate linkages with community-based services and resources
• Maintain legal and clinical written records of each client’s case
• Ensure timely implementation of services and client needs
• Maintain effective communication with other disciplines
• Increase knowledge of care planning functions

Bilingual Korean Care Manager

General

• Ensure that member inquiries are addressed and that members are referred to the appropriate service provider(s)
• Administer policies and procedures for verifying member identity, membership status, and entitlement to services
• Maintain current and accurate membership databases and records
• Suggest new service offerings or revisions to existing programs based on member feedback or in response to member needs or gaps in coverage
• May participate in member retention or renewal efforts
• Actively support the achievement of SCAN’s Vision and Goals
• Other duties as assigned

Grievances and Appeals Coordinator

Account Executive

• Achieve all broker sales targets.
• Maintain business relationships with brokers, general agency representatives and ancillary stakeholders by providing outstanding service to all in assigned territory.
• Expand the broker sales distribution channel by identifying, training and certifying new agencies and brokers.
• Coordinate and present all broker education curriculum, including the SCAN Broker Certification training for all new brokers.
• Monitor broker quality; resolve issues to ensure high-quality representation of SCAN.
• Ensure brokers are utilizing current marketing materials and forms and administer broker supply/material requests.
• Assist with enrollments by verifying and processing broker requests and resolving member inquiries and plan eligibility issues.
• Contribute to team effort by accomplishing related results as needed.
• Provide reporting on new business opportunities, issues encountered in the field with respect to network, claims, customer service, marketing, etc.
• Maintain all federal, state and CMS compliance requirements as it pertains to the administration of the broker distribution channel.
• Work closely with marketing staff to implement and execute on broker cooperative marketing campaigns.

Broker Account Executive – Northern and Southern CA, Houston TX

QA Engineer

• Ensure compliance with regulatory and company/departmental standards by monitoring staff and processes, and implementing corrective action, as required
• Improve service quality and efficiencies by developing and implementing standards, workflows and processes that are compliant with regulatory requirements
• Maintain regulatory compliance by remaining knowledgeable of regulations and contractual requirements related to customer service operations
• Ensure the SCAN commitment of service excellence by ensuring that staff consistently provide a level of service that meets or exceeds the customer’s expectation
• Identify and remediate deficient practices/processes by monitoring processes and staff interactions with customers
• 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
• Support the Member Services Trainer by providing feedback on training needs

Quality Assurance Specialist

Executive

• Provide day-to-day supervision and oversight for the Member Experience Champion team
• Ensure effective management of complex, high-risk, and high-impact member escalations
• Support Champions as they resolve critical issues and act as escalation partners for leadership
• Assign cases, monitor daily escalation pathways, and ensure work progresses according to internal workflows, SLAs, and compliance requirements
• Provide ongoing coaching, feedback, and quality monitoring for Champions
• Review and approve written responses, case summaries, and documentation prepared by Champions
• Guide Champions in coordinating with clinical, operations, compliance, legal, and provider/network partners to resolve complex cases
• Coach Champions on advanced service recovery strategies and member communications
• Ensure Champions maintain accurate, consistent documentation of all escalations, outreach, findings, and resolution actions
• Provide routine updates to leadership on queue status, case aging, quality findings, and team capacity
• Lead efforts to enhance playbooks, templates, and knowledge resources

Supervisor, Executive Escalations

Security Engineer

• AI Vendor & Technology Evaluation
• Secure AI Implementation Guidance for Development Teams
• AI Risk Management & Compliance
• Security Integration Reviews
• Training , Awareness & Policy

AI Security Engineer – GRC

• Responsible for the oversight, training and servicing of the broker distribution channel in the assigned market aiming to position our health plan for sales achievement and success.
• Achieve all broker sales targets; this is a sales achievement position and success will be measured by attainment of sales targets.
• Maintain business relationships with brokers, general agency representatives and ancillary stakeholders by providing outstanding service to all in assigned territory.
• Expand the broker sales distribution channel by identifying, training and certifying new agencies and brokers.
• Coordinate and present all broker education curriculum, including the SCAN Broker Certification training for all new brokers.
• Monitor broker quality; resolve issues to ensure high-quality representation of SCAN.
• Ensure brokers are utilizing current marketing materials and forms and administer broker supply/material requests.
• Assist with enrollments by verifying and processing broker requests and resolving member inquiries and plan eligibility issues.
• Provide reporting on new business opportunities, issues encountered in the field with respect to network, claims, customer service, marketing, etc.
• Maintain all federal, state and CMS compliance requirements as it pertains to the administration of the broker distribution channel.
• Work closely with marketing staff to implement and execute on broker cooperative marketing campaigns.
• Actively support the achievement of SCAN’s Vision and Goals.

Broker Account Executive – Nye & Clark Counties

• Responsible for the oversight, training and servicing of the broker distribution channel in the assigned market aiming to position our health plan for sales achievement and success.
• Achieve all broker sales targets.
• Maintain business relationships with brokers, general agency representatives and ancillary stakeholders by providing outstanding service to all in assigned territory.
• Expand the broker sales distribution channel by identifying, training and certifying new agencies and brokers.
• Coordinate and present all broker education curriculum, including the SCAN Broker Certification training for all new brokers.
• Monitor broker quality; resolve issues to ensure high-quality representation of SCAN.
• Ensure brokers are utilizing current marketing materials and forms and administer broker supply/material requests.
• Assist with enrollments by verifying and processing broker requests and resolving member inquiries and plan eligibility issues.
• Provide reporting on new business opportunities and issues encountered in the field with respect to network, claims, customer service, marketing, etc.
• Maintain all federal, state and CMS compliance requirements as it pertains to the administration of the broker distribution channel.
• Work closely with marketing staff to implement and execute on broker cooperative marketing campaigns.

Broker Account Executive – Arizona, Maricopa, Pinal, Pima

• 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 applying 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 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 member, 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.

Bilingual SAL Advocate

Implementation Specialist

• 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.