Remote PA/PD 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

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.