Sr. Manager, Quality Assurance and Compliance - Health Plan Operations

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 Senior Manager of Quality Assurance and Compliance - Health Plan Operations is responsible for establishing and maturing an effective quality and compliance program across Operational areas, specifically Claims, Grievances and Appeals, Payment Configuration, Billing, Enrollment, etc. This includes evaluating operational controls, guidelines, tools and processes for monitoring, reviewing audits meet accuracy, timeless and contractual obligations, and enhancing operational processes.

This role serves as the second line of defense for the organization ensuring the organization is adhering to regulations and maintain high quality standard in operations. This function plays a vital role in ensuring the accuracy, timeliness, and efficiency of operations processing and maintaining compliance with regulatory and operational requirements.

You Will

• Responsible for developing and implementing a quality assurance program, reviewing audits meet accuracy, timeless and contractual obligations, and enhancing operational processes.

• Partner with Operations leadership to design and develop an effective Quality Assurance and Compliance program gaining alignment on methodology, audit approach, KPIs, standards and issue resolution process

• Manage quality and Compliance reporting. Coordinate accurate and timely submission of data, including audit readiness and documentation standards for Operations

• Collaborate with operational partners to align workflows, address barriers to performance, and implement initiatives to enhance operations and member satisfaction.

• Monitor and communicate performance trends track and analyze key performance indicators (KPIs). Share actionable insights and recommendations with senior leadership to inform strategic planning and resource allocation.

• Establish effective governance framework to include Audit the Auditor mechanism to achieve organizational goals related to quality and compliance.

• Lead a team of quality assurance and compliance professionals mentoring, fostering positive team culture, promote leadership growth, encourage innovation, and continuous learning to achieve team or individual goals

• Identifying trend and areas of opportunity for process improvements and additional training Work closely with operations leadership to review finding, develop action plans and remediate issues

• Partner with operational leadership to review finding, develop corrective action plans, and remediate identified issues to the root cause ensuring a closed loop process

• Monitor industry trends, regulatory changes and current events to ensure team remains informed and adapts to evolving policies and procedures.

• Supervises/Manages Others (i.e. hires, performance reviews, corrective action, etc.)

• 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 required. Graduate or Advanced Degree or equivalent experience preferred.

• Audit Certification preferred.

• 5 years of related experience QA and compliance operations experience with Medicare and Medicaid across Operational areas, specifically Claims, Grievances and Appeals, Payment Configuration, Billing, Enrollment, etc.

• 3+ years’ management experience in healthcare environment, preferably Medicare Advantage.

• 8+years of progressive experience in healthcare or health plan operations.

• Experience managing Quality Assurance and/or Operations Audit team.

• Experience working with AI or other machine learning tools to assist with streamlining QA processes.

• Deep experience in operational areas such as claims, configuration, provider data, benefits, enrollment, appeals and grievances.

• Proven success leading quality and compliance in a matrixed environment

• Strong working knowledge of CMS and state regulations and operational implications.

• Leadership - Skilled to develops others.

• Problem Solving - Make critical decisions, often involving high-level risk assessment and the ability to adapt to changing circumstances.

• Strategic Mindset - Formulates strategy and maps steps to achieve strategic goals.

• Business Insight - In-Depth understanding of the business.

• Strong verbal and written communication skills and interpersonal skills.

• Strong analytical and critical thinking skills.

• Detail oriented, organized and strong time management skills.

What's in it for you?

• Base salary range: $125,400 to $181,419 per year

• Work Mode - Partially 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.

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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)