Health Care Analyst III

Company Background

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 277,000 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 (Use the "Apply for this Job" box below). , or follow us on Linked In, Facebook, and Twitter.

Develops, documents, and programs in support of 5‑Star projects and in-house initiatives. In pursuit of high 5‑Star ratings, conducts in-depth data analysis and interpretation, HEDIS reporting, and other related tasks.

• Responsible for research and moderate analysis of Medicare Advantage and healthcare data specific to membership, provider, claims, authorizations, pharmacy, and financial information.
• Designs and produces timely and meaningful analysis and data interpretation regarding large health care related datasets, related to 5‑Star ratings, HEDIS, state specific programs (such as QIP/PIP), programs issued by state agencies (such as DHCS or HSAG) and other associated company initiatives.
• Leads in development, implementation, and document quality assurance (QA) processes to ensure that reported data is accurate and reliable.
• Conducts data management, quality improvement studies, statistical analysis, and report generation. Presents findings to higher level Analysts as well as HCI mid and senior management.
• Performs moderate to complex analysis and interprets organizational data, including but not limited to data mining, data verification, mapping, scrubbing, and scrapping.
• Develops and deliver actionable and supportable findings within tight deadlines and changing requirements.
• Conducts investigative research to uncover root causes, interpret results, identify trends, and make recommendations for action.
• Works directly with internal and external stakeholders to troubleshoot and correct data anomalies.
• Manages multiple moderate to complex projects concurrently. Completes them accurately within a specified timeline by effectively prioritizing work and communicating workload issues to management.
• Leads in training, providing guidance, and supporting lower level Analysts.
• Serve as a point of contact for internal and external customers and resolves both routine and more complex questions and problems. Escalates only the most complex issues to higher levels as needed.
• Ensures understanding of business needs by proactively monitoring and clarifying the technical responses to business requirements on all Medicare related projects.
• 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.

• Bachelor’s or above degree in Math, Statistics, Biostatistics, Computer Science, or other quantitative disciplines required.
• 5+ years of analytical experience, or 4+ years of analytical experience in a Healthcare/Managed Care environment required.
• Experience with HEDIS is preferred.
• Experience with medical claims / encounters data is preferred.
• MS Office required.
• Proficiency with MS SQL (queries) required.
• SQL Server Reporting Services and SQL Server Integration Services experience preferred.
• SAS (Statistical Analysis System)…