Jobs in the United States

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Added 53 mins ago
W
Auto Care Center Service Manager
Walmart
ARVADA, CO
- $23 to $36 USD / hour
Live Better U is a Walmart-paid education benefit program for full-time and part-time associates in Walmart and Sam's Club facilities. Programs range from high school completion to…
Added 53 mins ago
Senior Social Worker-Home Based Primary Care
Veterans Affairs, Veterans Health Administration
Grand Junction, CO
Added 53 mins ago
Senior Social Worker-Home Based Primary Care
Veterans Affairs, Veterans Health Administration
Grand Junction, CO
Added 53 mins ago
HH
Case Management Assistant
HCA Healthcare
Englewood, CO
- $19.5 to $27.28 USD / hour
…serves as the region’s preeminent referral center for the most advanced stroke treatment and was the state’s first Joint Commission-certified Comprehensive Stroke Center. HCA HealthONE…
Added 53 mins ago
Account Manager -SMB Sales
Verizon Communicatio
Boulder, CO
…commission. Planning to go above and beyond? Our commission program allows unlimited opportunity, which could allow top earners to exceed compensation plans and compete for various sales…
Added 54 mins ago
Marketing and Business Development Coordinator
Brendle Group
Fort Collins, CO
…development, and analyze data that informs client strategies and program outcomes. This is an excellent opportunity for someone interested in sustainability marketing, consulting, and…
Added 54 mins ago
Cyber Security Assessment Manager - Digital Assets
Crowe LLP
Denver, CO
…role comes from a growth mindset, strong communication skills, advanced critical thinking, and the ability to navigate new challenges with confidence. About the Role Crowe is seeking a…
Added 1 hour ago
Medical Support Assistant - Advanced
Veterans Affairs, Veterans Health Administration
Indianapolis, IN
Added 1 hour ago
W
Auto Care Center Service Manager
Walmart
HUNTSVILLE, AL
- $20 to $33 USD / hour
Live Better U is a Walmart-paid education benefit program for full-time and part-time associates in Walmart and Sam's Club facilities. Programs range from high school completion to…
Added 2 hours ago
Security Officer, BlueOval Battery Park Michigan
Ford Motor Company
Marshall, MI
build and lead an agile team to deliver the advanced technology that drives the future
Added 2 hours ago
Ford Racing Partnerships Specialist
Ford Motor Company
Allen Park, MI
…global sponsorship and partnership portfolio. Report to the Manager, Global Partnerships, this individual will play a critical role in identifying, developing, and supporting commercial…
Added 2 hours ago
Lifecycle Cost Manager
Ford Motor Company
Allen Park, MI
As Global Lifecycle Cost Manager (LL5) for Unit Programs, you will direct a team of supervisors and analysts driving competitive material costs across Ford’s global propulsion technologies…
Added 2 hours ago
Purchasing Manager, Supply Chain - Lighting
Ford Motor Company
Dearborn, MI
The Ford Supply Chain team is central to our ability to build great vehicles. As the manager for Lighting, your team will be responsible for the sourcing of high‑quality components while…
Added 2 hours ago
ITSM - Product Designer
Ford Motor Company
Dearborn, MI
…future of mobility. If you’re looking for the chance to leverage advanced technology to redefine the transportation landscape, enhance the customer experience and improve people’s lives,…
Added 2 hours ago
Manager, HR Business Partner
Ford Motor Company
Dearborn, MI
If you are looking for an opportunity to become part of a dynamic Human Resources team your search ends here! Ford has an exciting opening for a Manager, HR Business Partner.
Added 2 hours ago
W
Auto Care Center Service Manager
Walmart
CARLSBAD, NM
- $22 to $35 USD / hour
Live Better U is a Walmart-paid education benefit program for full-time and part-time associates in Walmart and Sam's Club facilities. Programs range from high school completion to…
Added 3 hours ago
UB
Experience Manager
Ulta Beauty, Inc.
Rensselaer, NY
- $28.5 to $35 USD / hour
The Experience Manager (EM) is responsible for leading through Ulta Beauty’s mission, vision, and values in order to develop a high-performing team that consistently delivers top-line sales…
Added 6 hours ago
Data Operations Manager, Scientific Data
Axiom
South San Francisco, CA
…failure. Our high-throughput human liver safety platform combines advanced human cell systems with imaging, transcriptomics, mass spectrometry, and drug metabolism measurements. Our AI…
Added 6 hours ago
Controller Manager
Graphic Packaging International, LLC
Sioux Falls, SD
…to workplace diversity and offer compensation and benefits programs that are among the industry’s best to reward the talented people who make our company…
Added 6 hours ago
Medical Laboratory Technician
Veterans Affairs, Veterans Health Administration
Sioux Falls, SD
Added 6 hours ago
Medical Support Assistant
Veterans Affairs, Veterans Health Administration
Sioux Falls, SD
Added 7 hours ago
Registered Nurse, Assistant Manager Procedural and Surgical Services, FT Days - VWCH
Vanderbilt University Medical Center
Lebanon, TN
…out our mission of moving medicine forward through preeminent programs in patient care, education and research. Here you’ll find a spirit of collaboration and a supportive community where…
Added 7 hours ago
Education Program Manager-Tennessee Memory Care Assessment Network
Vanderbilt University Medical Center
Nashville, TN
…out our mission of moving medicine forward through preeminent programs in patient care, education and research. Here you’ll find a spirit of collaboration and a supportive community where…
Added 7 hours ago
Community Outreach Program Manager-Tennessee Memory Care Assessment Network
Vanderbilt University Medical Center
Nashville, TN
…out our mission of moving medicine forward through preeminent programs in patient care, education and research. Here you’ll find a spirit of collaboration and a supportive community where…
Added 7 hours ago
Telephone Triage RN
Baystate Medical Practices, Inc
Springfield, MA
Under the direct supervision of clinical RN manager/Supervisor and with guidance performs all responsibilities as documented in New RN Graduate Ambulatory Residency job description.…

SHPCA SCAN Health Plan

Program Manager - Claims, Health Plan

Long Beach, CA, United States

$106,200 to $153,705 USD / year

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Job details

Pay: $106,200 to $153,705 USD / year
Experience: 2-3 years of leadership experience.
Posting language: English
Posted: Oct 29, 2026

Original 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

The Program Manager - Claims is accountable for claims escalations, provider abrasion, service issues, pricing, payment policy interpretation, and the investigation and resolution of complex, high-dollar claims. This role ensures claims are adjudicated according to policies, contracts, and regulatory requirements; collaborates with internal and external partners to resolve issues; and analyzes data to identify trends, operational problems, cost savings, and process improvement opportunities.

The position leads claims triage and management for AEP/OEP, supports Total Cost of Care initiatives, and works directly with senior leadership to develop resolution solutions for escalated cases

You Will

Manage claims escalations, provider abrasion, service issues, pricing matters, and payment policy interpretation.
Investigate and resolve complex, high-dollar claims and ensure claims are adjudicated according to policies, contracts, and regulatory requirements.
Work with providers, members, Medical Management, Coding, Billing, and Finance to resolve claims issues.
Analyze claims and operational data to identify trends, operational problems, cost savings, and process improvement opportunities.
Collaborate with Network Management and work directly with external partners, as needed, to address claims-related issues.
Lead claims triage and management for the Annual Enrollment Period and Open Enrollment Period (AEP/OEP).
Support Total Cost of Care initiatives by identifying and implementing opportunities to improve efficiencies.
Support staffing plans and resource allocation for claims programs and initiatives.
Manage vendor or third-party claims relationships, when applicable.
Support system implementations and claims-platform upgrades, including leading testing and workflow changes, and partner with senior leadership to develop resolution solutions for escalated cases.
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

Bachelor's Degree or equivalent experience in Business Administration, Healthcare Administration, Finance, or a related field; or an equivalent combination of education and experience.
2-3 years of leadership experience.
5 or more years of progressive experience in healthcare claims operations, claims analysis, or a related health plan function.
Experience managing cross-functional programs, complex claims issues, vendors, or claims-related initiatives.
Experience with Medicare Advantage claims operations and regulatory requirements preferred.
Strong knowledge of claims adjudication, claims operations, pricing, and applicable policies, contracts, and regulatory requirements.
Ability to interpret National Coverage Determinations and Local Coverage Determinations (NCD/LCD) and other payment policies.
Demonstrated ability to investigate and resolve complex, high-dollar, and escalated claims.
Strong analytical skills with the ability to identify trends, operational problems, cost savings, and process improvement opportunities.
Ability to collaborate effectively with providers, members, Medical Management, Coding, Billing, Finance, Network Management, vendors, and external partners.
Program and project management skills, including the ability to lead multiple priorities and deliver results.
Ability to support staffing plans, and resource allocation.
Experience supporting system implementations, testing, claims-platform upgrades, and workflow changes.
Strong written and verbal communication skills, including the ability to present issues and resolution solutions to senior leadership.
Ability to work independently, exercise sound judgment, and manage sensitive or highly escalated matters.
Leadership - Skilled to develops others
Problem Solving - Strong problem-solving skills
Optimizes Work Processes - Identifies and creates processes necessary to get work done
Advanced Microsoft Office Suite, Visio, and SQL experience are required.

What's in it for you?

Base salary range: $106,200 to $153,705 per year
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.

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)

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