Configuration Analyst II

SCAN Health Plan • Long Beach, CA

3d • Remote

About The Position

The Configuration Analyst II supports implementation, maintenance, and governance of SCAN Health Plan’s Benefit Configuration, including Prior Authorization (PA) and Pre-Determination (PD) code sets. This role ensures approved code sets are accurately and timely configured across claims, utilization management, and related operational systems. The Configuration Analyst I I partners with Medical Policy, Utilization Management, Configuration, Information Technology, delegated entities, providers, and vendors to support configuration, reporting, data analysis, system maintenance, and process improvement activities.

Requirements

• Bachelor's Degree or equivalent experience in Healthcare Administration, Health Information Management, Information Systems, Data Analytics, Business, Computer Science, or related field.
• 2 or more years of experience in healthcare systems, operations, analytics, medical coding, utilization management, or related technical functions.
• 2 or more years of experience with reporting, data analysis, SQL, or healthcare-related data.
• Experience working with healthcare coding systems, code set maintenance, or authorization-related processes.
• Knowledge of healthcare coding systems, including CPT®, HCPCS, and related code sets.
• Understanding of healthcare claims processing, utilization management, authorization workflows, and healthcare operations.
• Knowledge of CMS regulations and Medicare Advantage and Medicaid program requirements preferred.
• Strong analytical and problem-solving skills, including data interpretation, issue identification, root cause analysis, and solution development.
• Proficiency in data analysis, reporting, performance measurement methodologies, SQL, reporting tools, and business intelligence platforms preferred.
• QNXT experience is required.
• Proficiency with Microsoft Office Suite and related business productivity applications.
• Excellent written and verbal communication skills with the ability to explain technical concepts to technical and non-technical audiences.
• Strong organizational skills, attention to detail, and ability to manage multiple priorities and deadlines.
• Demonstrated ability to work independently while collaborating across multidisciplinary teams.
• Commitment to accuracy, quality, compliance, continuous improvement, and standard office-based work activities, including computer and office equipment use for extended periods.

Nice To Haves

• Experience managing Prior Authorization or Pre-Determination Lists.
• Experience working with Medicare Advantage and/or Medicaid managed care programs.
• Experience supporting healthcare claims, utilization management, or medical policy operations.
• Experience with business intelligence tools such as Power BI.
• Familiarity with healthcare vendor platforms such as MHK, ikaSystems, CareAxis, or similar applications.
• Experience utilizing AI-enabled analytical tools and automation technologies.
• Coursework or training in healthcare analytics, healthcare informatics, business intelligence, or database management.
• Certification or coursework in SQL and Power BI.
• Certification in healthcare analytics, data visualization, business intelligence, or related technical discipline.

Responsibilities

• Maintains PA and PD code sets across claims, utilization management, and related operational systems.
• Supports benefit configuration and prior authorization activities, including configuration, 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, technical inquiries, and system problems impacting operational workflows.
• Supports Annual Enrollment Period (AEP) readiness by completing assigned benefit configuration activities, validating configuration accuracy, and meeting established implementation timelines.
• Analyzes data to identify trends, risks, process improvement opportunities, and operational or financial impacts.
• Supports continuous improvement initiatives by enhancing workflows, reporting capabilities, data quality, system functionality, and operational efficiency.
• Creates and maintains procedures, workflow documentation, training materials, and other resources supporting PA and PD list operations.
• Maintains knowledge of healthcare coding standards, authorization processes, CMS regulations, healthcare technology, and related best practices.
• Actively support the achievement of SCAN’s Vision and Goals.
• Other duties as assigned.

Benefits

• Base salary range: $71,700 to $103,732 per year
• 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!

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree