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$106k–$183k/yr
Full-time
bachelor degree, postgraduate degree
Annual employee bonus program, Wellness program, Paid time off, 11 paid holidays, 401(k) retirement saving plan with employer match, Employee recognition program
Posted 18d ago
~40 hrs/week
Remote in United States
Responsibilities
This role identifies and quantifies total cost of care savings opportunities by applying data science and AI-enabled analytics to claims, clinical, and contract data. The incumbent collaborates with cross-functional stakeholders to translate analytic findings into actionable medical cost management strategies.
Requirements
Candidates must possess a graduate degree in a quantitative field and at least 3 years of experience in data science, preferably within the healthcare industry. Proficiency in SQL, Python or R, and experience with cloud data platforms like Snowflake or Databricks are required.
Full job description
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.
The Job
This role will be a key member of SCAN's Medical Economics Analytics team, responsible for identifying, quantifying, and helping capture total cost of care (TCOC) savings opportunities across the health plan's core medical cost management levers: clinical programs, utilization management (UM) and medical policy, payment integrity, network and contracting, benefit design, coordination of benefits (COB), and supplemental programs. The role combines strong health plan operations knowledge with data science methods and AI-enabled analytics tooling (GenAI, agentic workflows) to surface and size opportunities from claims, clinical, and contract data.
This role will collaborate with clinical, network, payment integrity, and finance stakeholders to convert analytic findings into total cost of care strategy, in support of SCAN's mission of keeping seniors healthy and independent.
You Will
1. Apply data science and analytical methods (such as segmentation, trend analysis, statistical modeling, and GenAI-enabled synthesis) to claims, clinical, and contract data to identify, size, and prioritize total cost of care (TCOC) savings opportunities across SCAN's core medical cost management levers. Illustrative examples could include:
Utilization management (UM) and medical policy: evaluating program effectiveness, medical policy application and exception patterns, and utilization outliers
Payment integrity: identifying claims coding, billing, and payment accuracy opportunities (e.g., DRG validation, upcoding, duplicate payment, coordination of benefits recovery)
Network and contracting: analyzing unit cost, provider relativity, and site-of-service shift to inform contracting strategy
Benefit design and coordination of benefits (COB): evaluating benefit changes and COB recovery opportunities for cost and member impact
Supplemental programs: assessing utilization, cost, and return on investment
Clinical programs: building segmentation and predictive models to prioritize cost management interventions
AI-enabled synthesis: applying GenAI and agentic AI tools to synthesize claims, clinical, and contract data and accelerate opportunity identification
2. Leverage strong health plan operations knowledge and business acumen to identify and prioritize total cost of care opportunities based on SCAN’s highest-value medical cost management levers
3. Create requirements, test and validate analyses, communicate findings and savings opportunity sizing to Medical Economics, Finance, Network, and Clinical business partners, and support opportunity tracking through implementation.
4. Help shape and implement SCAN’s medical economics analytics and AI strategy in coordination with key stakeholders across the company. Manage multiple projects at a time based on the priorities and delivery methodologies of the Medical Economics Analytics team, while also being a mentor to other analytics practitioners.
Your Qualifications
Bachelors Degree in statistics, mathematics, computer science, or related field required
Graduate or Advanced Degree in statistics, mathematics, computer science, or related field required
3+ years working experience, preferably including healthcare industry experience
3+ years applying data science and analytical methods (e.g., statistical modeling, segmentation, trend analysis, machine learning, GenAI/agentic AI) to identify and quantify business or medical cost opportunities
1+ years of experience writing SQL code in relational database environment
2+ years of experience writing code in Python and/or R
Experience with Snowflake and/or Databricks as well as Power BI.
Experience with Streamlit or other data as a service apps, preferred
Working knowledge of GenAI/LLM tools for synthesizing structured and unstructured health plan data (claims, clinical notes, contracts), preferred
Experience in a Medicare Advantage or other managed care environment, preferred.
Clinical code knowledge related to claims/utilization, preferred.
Experience identifying and quantifying medical cost management opportunities across levers such as utilization management, medical policy, payment integrity, network/contracting, benefit design, coordination of benefits, and supplemental programs, preferred.
Familiarity with payment integrity concepts (DRG validation, claims editing, coordination of benefits recovery, billing/coding accuracy), preferred.
Understanding of claims and encounter data structures (837/835, UB-04, CMS-1500, DRG, revenue codes, ICD-10, CPT/HCPCS), preferred.
Familiarity with core managed care economics (PMPM, MLR, IBNR) and total cost of care trend decomposition, preferred.
Working knowledge of Medicare Advantage risk adjustment (HCC/RAF methodology), preferred.
Expertise in Snowflake and Databricks for ML/AI workloads, including optimization and governance.
Hands-on experience with LLM development (RAG, embeddings/vector databases, document summarization, chatbot/agent integration using LangChain / LangGraph or similar tools).
Familiarity with BI tools (Power BI, Tableau, Streamlit) and integrating ML outputs for business facing solutions.
Strong interpersonal skills, including excellent written and verbal communication skills.
Familarity with MLOps practices, including MLflow, Azure DevOps, monitoring, and alerting.
Ability to appropriately maintain confidentiality.
Familiarity with Agile delivery methodologies (e.g. Scrum, SAFe)
Working knowledge of health plan data domains (claims, encounters, eligibility, provider, authorizations, contracts) supporting total cost of care analytics.
Fluency in managed care economics and coding conventions (PMPM, MLR, DRG, HCC/RAF) sufficient to translate model output into financial impact.
Ability to translate medical cost management levers (UM, medical policy, payment integrity, network, benefit design, COB, supplemental programs) into analytic requirements and opportunity sizing frameworks.
Excellent written and verbal communication skills, with ability to explain AI/ML concepts to business and technical audiences.
Connects technical work to strategic health plan objectives, particularly total cost of care management across clinical, payment integrity, network, benefit design, and supplemental program levers
Learns emerging AI/ML tools and healthcare regulations quickly and applies them responsibly in production environments
Knowledge of real-world data (RWD), claims, EMR, and similar healthcare data; working fluency in health plan cost management concepts (PMPM, DRG, HCC/RAF risk adjustment, payment integrity, coordination of benefits) preferred
What's in it for you?
Base Pay Range: $106,200 to $182,983 annually
An annual employee bonus program
Robust Wellness Program
Generous paid-time-off (PTO)
11 paid holidays per year, 1 floating holiday, birthday off, and 2 volunteer days
Excellent 401(k) Retirement Saving Plan with employer match
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.
#LI-JB1 #LI-Remote
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)
Related keywords
Data ScienceMedical EconomicsTotal Cost of CareClaims DataGenAIMachine LearningSQLPythonRSnowflakeDatabricksPower BIMedicare AdvantageUtilization ManagementPayment IntegrityPredictive Modeling
SCAN is a mission-driven organization that is tackling some of the biggest issues in health care for older adults.
Industry
Hospitals and Health Care
Company size
1,001-5,000 employees
Founded
1977
Headquarters
Long Beach, California
LinkedIn followers
52,298
About SCAN
Keeping Seniors Healthy and Independent–that’s been our mission for more than 40 years. Founded in Long Beach, CA in 1977 by a group of senior activists committed to improving access to the care and services they needed as they aged, SCAN is a recognized leader in senior care. As one of the nation’s largest not-for-profit Medicare Advantage plans, SCAN also provides a range of community services, including the innovative programs of Independence at Home and robust community education and community giving.
The SCAN mission is not something that just hangs on the wall, it’s a commitment understood and embraced by every employee. We believe in supporting our employees so they, in turn, can support our members as well as seniors and caregivers in the communities we serve. That means providing training, tools and opportunities for growth—and rewarding jobs well done.
Our employees enjoy:
- A competitive compensation and benefits program
- An annual employee bonus program
- Generous paid-time-off (PTO)
- Ten paid holidays per year
- Excellent 403(b) Saving Plan, providing up to 4% match and vesting after
three years
- Casual attire . . . wear jeans every day!!
- A work-life balance and much more!
Want to learn more about SCAN? Visit us at scanhealthplan.com
Offices: Long Beach, California 90806, US
Senior healthcareHealth CareElder CareMedicalHome Health Care
How many Healthcare jobs are open in Long Beach, CA right now?
There are currently 725 open healthcare positions in Long Beach, CA listed on Clera. New openings are added daily as companies post roles.
Which companies are hiring for Healthcare roles in Long Beach, CA?
Companies currently hiring include Molina Healthcare, SCAN, Lorian Health, Ascendiun, St. Mary Medical Center, among others. Browse the listings above to see every active employer.
Are there remote or hybrid Healthcare jobs in Long Beach, CA?
Yes — 188 of the 725 open healthcare positions offer remote or hybrid work (75 remote, 113 hybrid).
How do I apply for Healthcare jobs in Long Beach, CA?
Each listing links directly to the employer's application page. Apply early — fresh listings get the most recruiter attention in the first two weeks.