Remote Benefits Configuration Analyst II

SCAN Health Plan; Lakewood (CA); Hybrid; USD 72,000 - 104,000; Full time

Benefits offered by this job

Annual bonus

Wellness program

PTO

11 holidays + birthday/float

Job summary

SCAN Health Plan is seeking a Configuration Analyst II to support the configuration, maintenance, and governance of benefit code sets including Prior Authorization and Pre-Determination. You will collaborate with Medical Policy, Utilization Management, IT, and external partners to ensure accurate configuration across claims and related systems.

You will analyze data to identify trends, risks, and opportunities for process improvement, while creating training materials and procedures to support

Qualifications

• 2+ years of experience in healthcare systems, operations, analytics, medical coding, utilization management, or related technical functions.
• Experience with reporting, data analysis, SQL, or healthcare-related data.
• Knowledge of CPT/HCPCS and related healthcare code sets.
• Understanding of CMS regulations and Medicare Advantage/Medicaid requirements.
• Strong analytical and problem-solving skills with data interpretation and root cause analysis.

Responsibilities

• Maintains PA and PD code sets across claims, utilization management, and related systems.
• Supports benefit configuration, testing, validation, deployment, and post-implementation review.
• Acts as a technical liaison for PA and PD configuration with internal teams, providers, and vendors.
• Troubleshoots and resolves configuration issues affecting workflows.
• Supports AEP readiness by validating configurations and meeting timelines.

Skills

Analytical thinking

Problem solving

Communication skills

Attention to detail

Education

Bachelor's degree or equivalent in Healthcare Administration, Health Information Management, Information Systems, Data Analytics, Business, Computer Science

Tools

QNXT

Power BI

SQL

Microsoft Office

ikaSystems

CareAxis

Job description

SCAN Health Plan is seeking a Configuration Analyst II to support the configuration, maintenance, and governance of benefit code sets including Prior Authorization and Pre-Determination. You will collaborate with Medical Policy, Utilization Management, IT, and external partners to ensure accurate configuration across claims and related systems.

You will analyze data to identify trends, risks, and opportunities for process improvement, while creating training materials and procedures to support