Sr. Business Analyst - Configuration & Payment Integrity

SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation's leading not-for-profit Medicare Advantage plans, serving more than 277,000 members in California, Arizona, Nevada, Texas and New Mexico. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 45 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare.

SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org, www.scanhealthplan.com, or follow us on LinkedIn, Facebook, and Twitter.

Job Description:

The Job

As a key member of the Configuration and Payment Integrity team, you will collaborate with business

stakeholders, particularly in the Payment Integrity function, to drive significant cost savings and reporting that help us achieve our Payment Integrity goals. You will manage, transform, and analyze data while leading Payment Integrity projects using agile methodologies and help shape our future vision of how Payment Integrity and advanced AI can enable our mission of keeping seniors healthy and independent.

You Will

• 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 (new vendor contracts, new revenue stream opportunities and upgrades of our existing payment integrity systems)

• Support our Payment Integrity team to identify key insights on how our payment integrity vendors can interact via SSO compliant websites.

• Analyze the voice of the provider on capitation reporting and payment integrity programs and identify drivers of payment integrity savings including root cause analysis especially on CMS premium reclamation for MSP and ESRD.

• Use new models to identify drivers of payment integrity savings across existing and new programs.

• Analyze and build BI around payment integrity metrics such as first pass, second pass and third pass opportunities on credit balance recoveries.

• Assess how Payment Integrity can transform the pre-payment and post-payment review on ER claims considering we have a significant upcoding issue via a recent proof of concept on ER claims.

• Write complex SQL queries to extract payment integrity data from the enterprise data warehouse.

• Support or help build personalization engines for payment integrity (e.g., next best action).

• We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.

• Actively support the achievement of SCAN's Vision and Goals.

• Other duties as assigned.

Your Qualifications

• Master's degree in business, statistics, analytics, technology or related discipline or equivalent experience

• 5-7 years of related experience, ideally at a health plan.

• Performs work under minimal supervision.

• Intuitively handles complex issues and problems, and refers only the most complex issues to higher-level

• staff.

• Possesses comprehensive knowledge of subject matter.

• Provides leadership, coaching, and/or mentoring to a subordinate group.

What's in it for you?

• Base Pay Range: $92,400 - $133,671 Annually

• Work Mode: Mostly Remote

• An annual employee bonus program

• Robust Wellness Program

• Generous paid-time-off (PTO)

• 11 paid holidays per year, plus 1 additional floating holiday

• Excellent 401(k) Retirement Saving Plan with employer match

• Robust employee recognition program

• Tuition reimbursement

• An opportunity to become part of a team that makes a difference to our members and our community every day!

We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!

At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.

SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)