Configuration Analyst II

SCAN Health Insurance; Long Beach (CA); Remote; USD 72,000 - 104,000; Full time

Benefits offered by this job

Mostly Remote

Annual bonus program

Wellness Program

PTO

Eleven paid holidays per year, plus 1浮

401(k) with employer match

Job summary

SCAN Health Plan is seeking a Configuration Analyst II to support the Benefit Configuration, including Prior Authorization and Pre-Determination code sets across claims and related systems.

You will collaborate with Medical Policy, Utilization Management, IT, and vendors to ensure accurate configuration, testing, deployment, and ongoing improvements, with a strong focus on data analysis and regulatory compliance.

Qualifications

• Bachelor’s Degree or equivalent in healthcare/IS field.
• 2+ years in healthcare systems, operations, analytics, medical coding, utilization management, or related technical functions.
• 2+ years of experience with reporting, data analysis, SQL, or healthcare data.
• Experience with healthcare coding systems (CPT/HCPCS) and related code sets.
• Understanding of claims processing, utilization management, and authorization workflows.
• CMS regulations and Medicare Advantage/Medicaid knowledge preferred.
• Strong analytical and problem-solving skills.
• Proficiency with data analysis, reporting tools, and BI platforms.
• QNXT experience is required.
• Proficiency with Microsoft Office.
• Excellent written and verbal communication.
• Strong organizational skills and ability to manage multiple priorities.
• Ability to work independently while collaborating across teams.

Responsibilities

• Maintains PA and PD code sets across claims, utilization management, and related systems.
• Supports benefit configuration and prior authorization activities, including testing, validation, deployment, and post-implementation review.
• Serves as a technical liaison for PA and PD configuration activities with internal teams, delegated entities, providers, and vendors.
• Troubleshoots and resolves benefits and authorization-related configuration issues and system problems.
• Supports AEP readiness by completing assigned configuration activities and meeting timelines.
• Analyzes data to identify trends, risks, and improvement opportunities.
• Supports continuous improvement of workflows, reporting, data quality, and system functionality.
• Creates and maintains procedures, workflow documentation, training materials, and other resources.
• Keeps knowledge of healthcare coding standards, CMS regulations, and best practices.
• Explores AI opportunities to enhance operations.

Skills

SQL

Data analysis

Reporting

Power BI

Healthcare analytics

Communication

Attention to detail

Independent work

Problem-solving

Education

Bachelor’s Degree or equivalent in a relevant field

Tools

QNXT

Job description

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the “12 Angry Seniors.” Their mission continues to guide everything we do.

Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults.

Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity.

At SCAN, we believe scale should strengthen—not dilute—our mission. We are building the future of care for older adults, grounded in purpose, accountability, and respect for the people and communities we serve.

The Job

The Configuration Analyst II supports implementation, maintenance, and governance of SCAN Health Plan’s Benefit Configuration, including Prior Authorization (PA) and Pre-Determination (PD) code sets. This role ensures approved code sets are accurately and timely configured across claims, utilization management, and related operational systems.

The Configuration Analyst I I partners with Medical Policy, Utilization Management, Configuration, Information Technology, delegated entities, providers, and vendors to support configuration, reporting, data analysis, system maintenance, and process improvement activities.

You Will

• Maintains PA and PD code sets across claims, utilization management, and related operational systems.
• Supports benefit configuration and prior authorization activities, including configuration, testing, validation, deployment, and post implementation review.
• Serves as a technical liaison for PA and PD configuration activities with internal teams, delegated entities, providers, and vendors.
• Troubleshoots and resolves benefits and authorization-related configuration issues, technical inquiries, and system problems impacting operational workflows.
• Supports Annual Enrollment Period (AEP) readiness by completing assigned benefit configuration activities, validating configuration accuracy, and meeting established implementation timelines.
• Analyzes data to identify trends, risks, process improvement opportunities, and operational or financial impacts.
• Supports continuous improvement initiatives by enhancing workflows, reporting capabilities, data quality, system functionality, and operational efficiency.
• Creates and maintains procedures, workflow documentation, training materials, and other resources supporting PA and PD list operations.
• Maintains knowledge of healthcare coding standards, authorization processes, CMS regulations, healthcare technology, and related best practices.
• 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

• Bachelor’s Degree or equivalent experience in Healthcare Administration, Health Information Management, Information Systems, Data Analytics, Business, Computer Science, or related field.
• 2 or more years of experience in healthcare systems, operations, analytics, medical coding, utilization management, or related technical functions.
• 2 or more years of experience with reporting, data analysis, SQL, or healthcare-related data.
• Experience working with healthcare coding systems, code set maintenance, or authorization-related 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 preferred.
• Strong analytical and problem-solving skills, including data interpretation, issue identification, root cause analysis, and solution development.
• Proficiency in data analysis, reporting, performance measurement methodologies, SQL, reporting tools, and business intelligence platforms preferred.
• QNXT experience is required.
• Proficiency with Microsoft Office Suite and related business productivity applications.
• Excellent written and verbal communication skills with the ability to explain technical concepts to technical and non-technical audiences.
• Strong organizational skills, attention to detail, and ability to manage multiple priorities and deadlines.
• Demonstrated ability to work independently while collaborating across multidisciplinary teams.
• Commitment to accuracy, quality, compliance, continuous improvement, and standard office-based work activities, including computer and office equipment use for extended periods.

Experience Preferred:

• Experience managing Prior Authorization or Pre-Determination Lists.
• Experience working with Medicare Advantage and/or Medicaid managed care programs.
• Experience supporting healthcare claims, utilization management, or medical policy operations.
• Experience with business intelligence tools such as Power BI.
• Familiarity with healthcare vendor platforms such as MHK, ikaSystems, CareAxis, or similar applications.
• Experience utilizing AI-enabled analytical tools and automation technologies.
• Coursework or training in healthcare analytics, healthcare informatics, business intelligence, or database management.
• Certification or coursework in SQL and Power BI.
• Certification in healthcare analytics, data visualization, business intelligence, or related technical discipline.

What’s in it for you?

• Base salary range: $71,700 to $103,732 per year
• Work Mode: Mostly Remote
• An annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO)
• Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday
• Excellent 401(k) Retirement Saving Plan with employer match and contribution
• 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!

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 Aff!

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)