Job Details

About SCAN

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 300,000 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.

The Job

The Senior Compliance Analyst - Grievance & Appeals is responsible for ensuring the accuracy, completeness, and regulatory compliance of grievance and appeal processes through regular monitoring, auditing, and analysis. This role oversees the quality and integrity of these processes, identifying areas for improvement and implementing corrective actions to maintain high standards of compliance and operational efficiency.

You Will

• Conduct Regular Monitoring: Regularly monitor the work of the grievance and appeal review team to ensure accuracy, completeness, and compliance with Medicare Advantage regulations and internal policies.
• Identify and Document Discrepancies: Detect and document any discrepancies or errors in the grievance and appeal processes, ensuring they are addressed promptly. Work with the Operations Analyst to update DTPs.
• Provide Feedback: Providing constructive feedback to individual contributors. Identifying areas for improvement and report to the leadership team.
  Ensure Regulatory Compliance: Verify that all grievance and appeal documentation and processes meet Medicare Advantage regulatory requirements and standards.
• Possesses comprehensive knowledge of subject matter. Provides leadership, coaching, and/or mentoring to a subordinate group.
• Monthly Universe Review: Perform data scrubbing to clean and standardize grievance and appeal data, ensuring it is accurate, complete, and consistent for reporting and analysis purposes.
• Complete a monthly audit of the ODAG and CDAG audit universes including scrubbing the data and validating data accuracy.
• Facilitate Continuous Improvement: Work closely with the grievance and appeal review team, as well as other departments, to facilitate continuous improvement and address any issues.
• Maintain Accurate Records: Keep accurate and organized records of all audit activities, findings, and corrective actions taken.
• Perform Root Cause Analysis: Perform root cause analysis to identify the underlying reasons for any errors or discrepancies, and recommend strategies to prevent recurrence.
• Track Corrective Actions: Track and monitor the implementation of corrective actions to ensure that identified issues are resolved effectively.
• 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

• At least 5 years of experience in Medicare Advantage Appeals & Grievances (or closely related).
• Medicare Advantage Appeals & Grievance (or closely related) experience required.
  Bachelor's Degree or equivalent experience
• Experience in healthcare, law, or other related field.
• Strong project management experience. Ability to manage multiple projects in a fast-paced environment while meeting deadlines.
• Attention to detail and critical thinking skills.
• Regulatory knowledge and technical proficiency.
• Analytical thinking and problem solving skills.
• Communication Skills: strong interpersonal skills and exceptional Oral and written communication skills.
• Strong organizational and time management skills.

What's in it for you?

• Base salary range: $71,700 to $103,732 per year
• Internal title: Compliance Analyst, Sr.
• 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!

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
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