Vice President, Claims and Provider Operations

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.

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 500,000 members in California, Arizona, Nevada, Oregon, Washington and Texas. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 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 visitwww.thescangroup.org,, or follow us onLinked

In;

Facebook; and Twitter.

The Vice President, Claims and Provider Operations leads the strategy, performance, and modernization of claims, configuration, provider data, payment integrity, and capitation operations. This role is accountable for building a high-performing, compliant, and scalable operating model that improves accuracy, timeliness, affordability, provider experience, and member outcomes.

The Vice President drives operational excellence through strong controls, payment integrity, configuration discipline, AI, automation, analytics, process redesign, and optimization of internal, vendor, and partner-enabled delivery capabilities.

Leads a multi-disciplinary organization across claims intake, adjudication, configuration, provider data operations, payment integrity, capitation, and operational support, ensuring alignment with enterprise strategy, regulatory requirements, financial performance, provider experience, and member outcomes.

Owns end-to-end operational accuracy, timeliness, compliance, and control performance across claims and provider operations, with accountability for claims turnaround time, auto-adjudication rate, pend rate, inventory aging, financial accuracy, procedural accuracy, payment accuracy, prompt-pay compliance, and avoidable interest exposure.

Leads the evolution and transformation of claims and provider operations through workflow simplification, delivery model optimization, elimination of unnecessary manual touchpoints, automation, artificial intelligence, predictive analytics, and continuous improvement practices that improve quality, productivity, scalability, cost per claim, and speed to resolution.

Partners closely with IT, EDI Operations, Finance, Network Management, Compliance, Clinical, Appeals and Grievances, and other business leaders to optimize claims system configuration, edit logic, benefit loading accuracy, provider and contract data integrity, accumulator logic, dispute root cause remediation, operational readiness, provider experience, and downstream member outcomes for new products, regulations, contracts, and…