SCAN

• Ensure accuracy of commission payments by auditing data, resolving discrepancies and enforcing compensation rules. • Analyze compensation trends and provide actionable insights on sales performance • Maintain and enhance commission systems, tools and workflows to improve efficiency, scalability, and transparency • Respond to sales inquiries regarding commission payments and provide clear explanations of compensation calculations • Drive continuous improvement initiatives to simplify processes, reduce errors, and enhance user experience

• Prepare and analyze data for Part D and develop comparisons between actual versus forecast. • Support ad-hoc analytics such as provider contracting, product development, and other customized projects to suit business needs. • Utilize the Data Warehouse efficiently to develop reports and extract data fields. • Analyze historical data trends in order to establish reasonable assumptions. • Assist the actuarial team with the development of Medicare Advantage bid pricings by keeping track of various input parameters and testing benefit scenarios. • Assist the financial budget and forecasts of pharmacy costs and the ongoing monitoring of actual results. • Proactively identify opportunities to streamline workflows, enhance model efficiency, and improve automation of existing processes. • Bring intellectual curiosity and a continuous improvement mindset to all assigned work, challenging the status quo where appropriate.

• Ensure compliance with regulatory and company/departmental standards by monitoring staff and processes, and implementing corrective action, as required • Improve service quality and efficiencies by developing and implementing standards, workflows and processes that are compliant with regulatory requirements • Maintain regulatory compliance by remaining knowledgeable of regulations and contractual requirements related to customer service operations • Ensure the SCAN commitment of service excellence by ensuring that staff consistently provide a level of service that meets or exceeds the customer’s expectation • Identify and remediate deficient practices/processes by monitoring processes and staff interactions with customers • Provide management with feedback on staff performance and participate in coaching of the staff • Improve service quality by measuring the quality, effectiveness and efficiency of the customer experience • Support the Member Services Trainer by providing feedback on training needs

• AI Vendor & Technology Evaluation • Secure AI Implementation Guidance for Development Teams • AI Risk Management & Compliance • Security Integration Reviews • Training , Awareness & Policy

• Provide day-to-day supervision and oversight for the Member Experience Champion team • Ensure effective management of complex, high-risk, and high-impact member escalations • Support Champions as they resolve critical issues and act as escalation partners for leadership • Assign cases, monitor daily escalation pathways, and ensure work progresses according to internal workflows, SLAs, and compliance requirements • Provide ongoing coaching, feedback, and quality monitoring for Champions • Review and approve written responses, case summaries, and documentation prepared by Champions • Guide Champions in coordinating with clinical, operations, compliance, legal, and provider/network partners to resolve complex cases • Coach Champions on advanced service recovery strategies and member communications • Ensure Champions maintain accurate, consistent documentation of all escalations, outreach, findings, and resolution actions • Provide routine updates to leadership on queue status, case aging, quality findings, and team capacity • Lead efforts to enhance playbooks, templates, and knowledge resources

• Serves members by being an advocate and point of contact for member questions and concerns regarding benefits, eligibility, referrals, claims and any other aspects of plan benefits and services. • Ensures member satisfaction by providing superior customer service and willingness to help at all time while maintaining a professional demeanor. • Provides quality customer service by applying SCAN Five Service Principles. • Educates members, family, providers and caregivers regarding benefits and plan options. • Accurately explains benefits and plan options in person, via email or telephonically. • Provides follow-up with members by clarifying customer's issue, determining the cause, and identifying and explaining the solution. • Escalates appropriate member issues to management or other departments as required. • Consistently meets and/or exceeds the departmental standards, including, but not limited to: quality, productivity, and adherence to schedule and attendance. • Responds appropriately and in a timely fashion to member/internal staff/providers by answering telephonic and written inquiries concerning benefits, eligibility, referrals, claims and all other issues following departmental policies and procedures and job aids. • Takes ownership of the issue, focusing on providing solutions and options for member, as necessary through resolution of member issue. • Increases member satisfaction by following up and resolving member issues, complaints, and questions in an efficient, timely and accurate fashion; coordinates resolution with providers and other departments as needed. • Participates in member calling projects as assigned by management to support the overall SCAN goal of membership retention. • Follows policies and procedures and job aids in order to maintain efficient and complaint operations; communicates suggestions for improvement and efficiencies to management; identifies and reports problems with workflows following proper departmental procedures; actively participates in departmental staff meetings and training sessions. • Follows all appropriate Federal and State regulatory requirements and guidelines applicable to Scan Health Plan operations, as documented in company policies and procedures. • Follows all HIPAA requirements. • Documents transactions by completing applicable member forms and summarizing actions taken in appropriate computer system and following standards set by the department or by other authorized individuals. • Temporarily responds to routine member questions and concerns on specific medical group call queues as part of skill development. • Contributes to team effort by accomplishing related results as needed.

• Serve as point person to speak with patients, family members, and providers to address concerns pertaining to care, transfers and authorizations • Ensure necessary inpatient and outpatient care or other services are rendered to SCAN members at the right time, the right level of care and at the right location, with end-to-end coordination, while adhering to all policies and procedures • Coordinate discharge needs from inpatient acute settings and skilled nursing facilities as appropriate for each member • Coordinate timely delivery of last cover day letters to skilled nursing facilities • Issue determinations within required regulatory timeframes • Apply evidenced-based criteria and guidelines, as well as clinical judgment and expertise, to help develop treatment plans • Review tasks assigned by Integrated Care Nurse Practitioners and coordinate member care accordingly • Review all acute/skilled nursing appeals and create detail explanation of non-coverage and reinstatement letters • Prepare, participate and facilitate high risk huddles and/or skilled nursing rounds • Maintain a list of high risk patients and conduct regular outreach calls to check on their health status • Develop effective working relationships and collaboration with Care Coordinators on clinical matters • Demonstrate excellent organizational, decision-making and multi-tasking skills as demonstrated by problem-solving and successful outcomes • Promote the mission, vision, and values of SCAN Health Plan and serve as an ambassador when interfacing and collaborating with external stakeholders

• Assess health plan needs of prospective members and verify Medicare / Medi-Cal eligibility. • Facilitate telephonic enrollment by presenting benefit information over the phone. • Follow all state and regulatory guidelines by adhering to programs implemented by CMS. • Adhere to required Sales Market Quota goals each month during LOCK IN and AEP. • Support Field Sales Representatives and contribute to team effort by accomplishing related results as needed.

• Responsible for the end-to-end onboarding, reporting, and certification processes for all internal and external agents and agency partner • Assist in producing reports that accurately measure, track and analyze agency and agent data for the Sales Team • Submit, process, review, and certify internal and external onboarding documents of all sales agents • Enter data into various databases, ensuring document security and compliance with legal and financial requirements, such as the verification of licensing, department of insurance, W-9, and training certifications • Identify, research and resolve agent contracting discrepancies and work with agents regarding licenses, training renewal and expiration dates • Resolve broker and agent contracting issues in a timely manner and escalate when appropriate • Coordinate with key functional departments including but not limited to compliance, finance, and marketing • Other duties as assigned.

• Coordinate end-to-end provider onboarding and offboarding management: Project manage all cross-functional tasks and deliverables associated with the provider onboarding, including pre-delegation audits, roster loading and display, MFT setup, claims payment configuration, and reporting activation to ensure seamless onboarding experiences. • Manage provider offboarding processes: Ensure smooth offboarding when a provider terminates or changes MSO affiliation by coordinating member reassignment, provider data removal, report deactivation, and compliant member communication in partnership with internal teams. • Develop and maintain workflows and documentation: Design, implement, and regularly update standardized workflows, procedures, and timelines to support consistent practices, operational readiness, and data integrity throughout the full provider lifecycle. • Ensure clear operational handoffs across departments and adherence to established timelines for onboarding and offboarding activities. • Collaborate with Network Training and Compliance teams: Partner with the Network Training Specialist for all education and training needs, and work with the Compliance team to confirm all policies, desktop procedures, and materials associated to provider onboarding and offboarding comply with regulatory and organizational standards. • Monitor project milestones and risk management: Track and analyze project deliverables, identify risks or process gaps, and coordinate timely resolutions with business partners to maintain accuracy and efficiency across operational readiness for provider onboarding and offboarding. • Serve as subject matter expert and liaison: Represent Network Management in cross-functional meetings and governance committees related to provider onboarding and offboarding, providing insight and expertise on provider implementation, configuration readiness, and operational optimization. • Ensure regulatory and audit readiness: Promote compliance and adherence to CMS, DMHC, DHCS, and NCQA requirements through accurate documentation, lifecycle tracking, and post-termination data closure activities to maintain audit preparedness and meet quality standards. • Facilitate provider communications, education, and presentations: Collaborate with Network Training and Communications teams to enhance provider onboarding materials, orientation tools, and outreach initiatives enhancing provider understanding and engagement. • Conduct provider presentations and engage directly with provider partners to ensure clarity around onboarding expectations, operational workflows, and ongoing requirements. • Drive continuous process improvement: Identify and implement enhancements to workflows, tools, templates, and reporting processes that increase efficiency, accuracy, and provider satisfaction throughout the lifecycle. • Support system modernization and integration efforts: Contribute to SCAN’s system improvement and migration projects by capturing business requirements, testing enhancements, validating changes, and supporting implementation during and after release.