Health Plan Data Scientist - Medical Economics Analytics
About the job
- A bachelor's degree in statistics, mathematics, computer science, or a related field is required.
- A graduate or advanced degree in statistics, mathematics, computer science, or a related field is required.
- At least 3 years of work experience, preferably including healthcare industry experience, is required.
- At least 3 years of experience applying data science and analytical methods such as statistical modeling, segmentation, trend analysis, machine learning, and generative or agentic artificial intelligence to identify and quantify business or medical cost opportunities is required.
- At least 1 year of experience writing Structured Query Language code in a relational database environment is required.
- At least 2 years of experience writing code in Python and/or R is required.
- Experience with Snowflake, Databricks, and Power BI is required.
- Expertise in Snowflake and Databricks for machine learning and artificial intelligence workloads, including optimization and governance, is required.
- Hands-on experience with large language model development, including retrieval-augmented generation, embeddings and vector databases, document summarization, and chatbot or agent integration using LangChain, LangGraph, or similar tools, is required.
- Familiarity with business intelligence tools such as Power BI, Tableau, and Streamlit and with integrating machine learning outputs into business-facing solutions is required.
- Familiarity with machine learning operations practices, including MLflow, Azure DevOps, monitoring, and alerting, is required.
- Ability to appropriately maintain confidentiality is required.
- Familiarity with Agile delivery methodologies such as Scrum and Scaled Agile Framework is required.
- Working knowledge of health plan data domains, including claims, encounters, eligibility, provider, authorizations, and contracts, is required.
- Fluency in managed care economics and coding conventions, including per-member-per-month, medical loss ratio, diagnosis-related group, and hierarchical condition category/risk adjustment factor, is required.
- Ability to translate medical cost management levers into analytic requirements and opportunity-sizing frameworks is required.
- Excellent written and verbal communication skills, including the ability to explain artificial intelligence and machine learning concepts to business and technical audiences, are required.
- Ability to connect technical work to strategic health plan objectives is required.
- Ability to learn emerging artificial intelligence and machine learning tools and healthcare regulations quickly and apply them responsibly in production environments is required.
- Apply data science and analytical methods such as segmentation, trend analysis, statistical modeling, and generative artificial intelligence-enabled synthesis to claims, clinical, and contract data to identify, size, and prioritize total cost of care savings opportunities across medical cost management levers.
- Evaluate utilization management and medical policy effectiveness, medical policy application and exception patterns, and utilization outliers.
- Identify claims coding, billing, and payment accuracy opportunities, including diagnosis-related group validation, upcoding, duplicate payment, and coordination of benefits recovery.
- Analyze unit cost, provider relativity, and site-of-service shifts to inform network and contracting strategy.
- Evaluate benefit changes and coordination of benefits recovery opportunities for cost and member impact.
- Assess utilization, cost, and return on investment for supplemental programs.
- Build segmentation and predictive models to prioritize cost management interventions for clinical programs.
- Apply generative and agentic artificial intelligence tools to synthesize claims, clinical, and contract data and accelerate opportunity identification.
- Use health plan operations knowledge and business acumen to identify and prioritize total cost of care opportunities based on high-value medical cost management levers.
- 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.
- Help shape and implement the medical economics analytics and artificial intelligence strategy in coordination with stakeholders across the company.
- Manage multiple projects at a time according to the priorities and delivery methodologies of the Medical Economics Analytics team.
- Mentor other analytics practitioners.
- Translate model output into financial impact and connect technical work to strategic health plan objectives.
- Experience with Streamlit or other data-as-a-service applications is preferred.
- Working knowledge of generative artificial intelligence and large language model tools for synthesizing structured and unstructured health plan data is preferred.
- Experience in a Medicare Advantage or other managed care environment is preferred.
- Clinical code knowledge related to claims and utilization is preferred.
- Experience identifying and quantifying medical cost management opportunities across utilization management, medical policy, payment integrity, network and contracting, benefit design, coordination of benefits, and supplemental programs is preferred.
- Familiarity with payment integrity concepts, including diagnosis-related group validation, claims editing, coordination of benefits recovery, and billing or coding accuracy, is preferred.
- Understanding of claims and encounter data structures, including 837/835, UB-04, CMS-1500, diagnosis-related group, revenue codes, ICD-10, and CPT/HCPCS, is preferred.
- Familiarity with core managed care economics, including per-member-per-month, medical loss ratio, incurred but not reported, and total cost of care trend decomposition, is preferred.
- Working knowledge of Medicare Advantage risk adjustment, including hierarchical condition category/risk adjustment factor methodology, is preferred.
- Knowledge of real-world data, claims, electronic medical records, and similar healthcare data is preferred.
About the company
SCAN provides Medicare Advantage health coverage for seniors and runs community programs to help them stay healthy and independent. Members enroll in SCAN’s Medicare Advantage plan for medical benefits, while in-home care and programs like Independence at Home and Volunteer Action for Aging support aging in place. As a not-for-profit with a history dating to 1977, SCAN differentiates itself with a strong focus on seniors, caregivers, and broad community services, along with solid employee benefits. The goal is to improve access to care and strengthen communities so seniors can live independently and safely at home.
Company Size
1,001-5,000
Company Stage
N/A
Total Funding
N/A
Headquarters
Long Beach, California
Founded
1977
Get referred to SCAN
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Simplify's Take
What believers are saying
- SCAN posted 40.6% membership growth on February 3, 2026, adding 127,000 members.
- Walmart and SCAN announced a co-branded plan on September 16, 2026, targeting 2 million enrollees.
- SCAN appointed Dr. Gabriel Waterman chief clinical officer on September 25, 2026, sharpening outcomes control.
What critics are saying
- SCAN sued HHS and CMS on July 7, 2026 over star-rating calculations.
- An adverse D.C. ruling cuts bonus payments, pressures pricing, and weakens 2027 enrollment growth.
- Retail partnerships can commoditize SCAN; if Costco and Walmart underperform, brand leverage evaporates.
What makes SCAN unique
- SCAN built a 40-year senior-care brand, now ranked top ten nationally in Medicare Advantage.
- Its nonprofit model and community services differentiate it from pure insurers chasing margins.
- Costco and Walmart partnerships embed SCAN in trusted retail ecosystems for seniors.
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Benefits
Wellness Program
Paid Vacation
Paid Holidays
401(k) Retirement Plan
401(k) Company Match
Performance Bonus
Tuition Reimbursement
Remote Work Options
Hybrid Work Options
Company News
'The disadvantage plan is all about denial': Clark Howard slams Costco's Medicare plans as growth slows to 3.8%. Clark Howard, one of Costco's loudest champions, is now warning members to think twice before trusting the warehouse club with their Medicare coverage. The stakes could not be higher: pick the wrong plan at 65 and a single hospital stay... This post may contain links from our sponsors and affiliates, and Flywheel Publishing may receive compensation for actions taken through them. "Costco. Do you know what you're doing here? You know who you're messing around with?" Consumer advocate Clark Howard, usually one of the warehouse club's biggest fans, said that on his show on October 5. He was responding to SCAN Costco Medicare Advantage. Costco (NASDAQ:COST | COST Price Prediction) and the nonprofit insurance company SCAN Health Plan launched this HMO on October 1. Coverage starts January 1, 2027, in 17 California counties and two Nevada counties. Howard called it "an experiment" and added, "fortunately I think it's only in two states." He calls these products "disadvantage plans" and says that when patients need care most, "the disadvantage plan is all about denial." He also pointed to "new data about the games that advantage plans play, not caring if they cost your health or your life to save them money." If you choose wrong at 65, one hospital stay can cost thousands of extra dollars. In most states, you may lose the chance to switch back. Costco is selling Medicare to members who are Aging into it. On September 28, Jim Cramer noted that Costco ended fiscal 2026 with 84.1 million members, up 4%, which was below expectations. He called that "a real problem." Ten days earlier, he said the club is "having problems getting younger people to sign up for membership." On the earnings call, Chief Financial Officer Gary Millerchip called the slowdown "a normalization" as younger members who signed up online move through renewals. Costco's most loyal members are reaching Medicare age, and the company now has a Medicare product to sell them. Shares trade near $921. That's up about 1% over the past year, following a 627% gain over ten years. Membership fee income still grew 7% to $1.85 billion last quarter, so the Medicare plans expand a services business that is still growing. Now available: The Definitive Guide to Retirement Income. Many successful investors eventually reach the same moment. The saving is done, the portfolio is built, and the question quietly changes from how much can I grow this to how much can I take out? Get that second question wrong and decades of good investing can come apart in a handful of years. That is exactly what The Definitive Guide to Retirement Income helps answer. It covers what your retirement could actually cost, which income sources are worth using, and the withdrawal math that decides whether the money lasts. It is free today from Fisher Investments. Read More Here" Prior authorization data backs up Howard's warning. Howard has this one right. Medicare Advantage plans use prior authorization: the insurance company has to approve many treatments before you can get them. Original Medicare rarely requires that. KFF figures for 2024 show insurance company denied 8% of Medicare Advantage prior authorization requests. Patients appealed just 12% of those denials, and 81% of the appeals won. So most denials get reversed when someone pushes back, yet very few people push back. The plan keeps the savings every time a patient gives up. Every Advantage plan caps what you pay for in-network care. The National Council on Aging puts the 2026 federal ceiling at $9,250. With Original Medicare plus a Medigap Plan G policy, the most you owe for covered care is the $283 Part B deductible. This cap is set very high. One bad health year changes which plan wins. Everyone pays the 2026 Part B premium of $203 a month. For this example, assume Plan G costs $180 a month. | Scenario | $0-Premium Advantage Plan | Original Medicare + Plan G | | Healthy year (example: $500 in copays) | $2,935 | $4,878 | | Bad year (you hit the cap) | $11,685 | $4,878 | In a healthy year, the Advantage plan comes out $1,943 ahead. In a year with a cancer diagnosis or a hip replacement, it costs you $6,807 more. Original Medicare also needs a separate Part D drug plan, which adds to that side's cost. The bigger problem is getting out. When you first enroll in Part B, you get a six-month window to buy Medigap, and insurance company must accept you. After that window closes, insurance company in most states can turn you down or charge more because of your health. If you pick Advantage now and get sick at 72, Plan G may be out of reach just when you need it (we mapped out this and the other surcharges and coverage gaps retirees run into in a free Medicare guide). Run these numbers before picking a costco-branded plan. * Get Plan G quotes for your age and ZIP code using Medicare.gov's plan finder. Add a year of Part B premiums and the deductible. The total is your worst-case year on Original Medicare. * Look up the out-of-pocket maximum in the Summary of Benefits for any Advantage plan you're considering, including SCAN Costco's, and add Part B premiums. The difference from step one is what a bad year would cost you. * Make sure your doctors, specialists and nearest hospital are in the HMO network. HMOs generally don't cover out-of-network care except in emergencies. * Find out whether your state lets you switch Medigap policies later without a health review. If it doesn't, treat the choice you make at 65 as close to permanent and plan for your worst year. Expect Costco and SCAN to market the plan to members during open enrollment. Run your worst-year numbers before you sign up. Released: The Definitive Guide to Retirement Income. (Sponsor) Most people spend their entire working lives focusing on one thing: growing a pile of money. Then they retire and discover the skill they actually need is close to the opposite. Turning that pile into steady income, year after year, through good markets and bad, without ever running out. It may be the least discussed and most consequential transition in personal finance, and plenty of otherwise careful investors walk into it with no real plan. That is exactly what The Definitive Guide to Retirement Income helps answer. It is a free guide from Fisher Investments covering what your retirement will really cost, where the cash flow should come from, and how much you can safely withdraw each year. Learn more here. Learn More Here" Disclaimer: Investing in securities involves a risk of loss. Past performance is never a guarantee of future returns. Investing in foreign stock markets involves additional risks, such as the risk of currency fluctuations. Guides are provided by Fisher Investments. The publisher may be compensated when readers request a guide. Jake FitzGerald Jake has been been working in financial media for almost 15 years. He focuses on all things personal finance for 24/7 Wall St. with high hopes to educate and entertain. Most recently, Jake spent 12 years working various roles at The Motley Fool. He started copy editing fool.com content, worked on premium and marketing campaigns, and helped launch The Ascent, a personal finance brand. His work has been featured on platforms like MSN, Yahoo Finance, USA Today, and more. He's written about credit cards, social security, ETFs, savings accounts, and just about anything else you can imagine when thinking about money. Jake love to cook, play golf, and tell people he's never had a cavity. (It's true!)
What's new in 2027: more choices, more benefits and more ways to get care. Whether you're exploring Medicare Advantage or already a SCAN member, there's a lot to look forward to in 2027. From new plans and partnerships to expanded service areas and benefits, SCAN is bringing more choices and more ways to get the care and support that fit your life. October 1, 2026 If you're looking for a Medicare Advantage plan, you've got a lot of options. But in 2027, SCAN Health Plan continues to do what SCAN Health Plan has always done: move forward with older adults at the center. SCAN is expanding into new communities across California, Texas and Oregon, bringing its nonprofit approach to even more older adults. New for 2027, SCAN is adding Sonoma County in California, Chambers and Liberty counties in Texas, and entering Oregon with plans in Clackamas and Washington counties. And SCAN Health Plan is growing in more ways than one. New and expanded partnerships with Costco, Walmart, Seoul Medical Group, CareMore, Sutter Health and The Springs Living are creating more ways for older adults to find a plan that fits their needs and connects them with care they know and trust. There's more to explore, too - from new Medicare Advantage plans and expanded benefits to more flexible ways to use everyday allowances and get rewarded for healthy choices. Whether you're new to SCAN or already a member, there's a lot to look forward to in 2027. New plans. New SCAN + Costco plans. Its partnership with Costco is growing, with new co-branded Medicare Advantage plans available in 19 counties across California and Nevada. Designed around simplicity, value and convenience, Costco plans feature $0-to-low monthly premiums, $0 PCP visits and $0 Tier 1 and Tier 2 drug copays. Members also have access to a pharmacy network designed for Costco plans, with Costco and independent pharmacies as preferred pharmacies. Plus, FlexEssentials allowances for eligible over-the-counter items and healthy foods, vision and hearing can be used at Costco. Benefits vary by market and plan. New SCAN + Walmart plans. SCAN is teaming up with Walmart to bring new Medicare Advantage plans to 9 counties across Arizona and Texas, including an HMO and a chronic condition special needs plan (C-SNP). Plans are designed around affordability and convenience, with benefits such as allowances for healthy foods and over-the-counter items, vision and dental care, plus transportation to Walmart preferred pharmacies. Benefits vary by market and plan. More plans built around the care you trust. SCAN is expanding its provider-specific offerings with new plans developed with Seoul Medical Group and CareMore in Los Angeles and Orange counties, giving members more opportunities to choose plans built around trusted local providers. New SCAN Baekse (HMO) and SCAN Ansim Care (HMO C-SNP) plans combine access to Seoul Medical Group with culturally and clinically competent care, in-language support and supplemental benefits designed around members' needs. SCAN Ansim Care is specifically designed for people with diabetes and certain cardiovascular conditions. The new CareMore offering provides access to an integrated model of care, including dedicated Care Centers designed to support everyday health needs as well as more complex, long-term conditions. A plan designed for LGBTQ+ older adults. SCAN Inclusive offers a redesigned approach developed specifically for LGBTQ+ older adults. In partnership with Included LGBTQ+ Health, members have access to dedicated care navigation, affirming-care support, peer resources and other services designed around the needs of the LGBTQ+ community. New options for older adults in Oregon. SCAN is entering Oregon with Springs Advantage and Springs Together, institutional special needs plans offered in partnership with The Springs Living in Clackamas and Washington counties. New benefits. More ways to use your FlexEssentials allowance. For 2027, FlexEssentials gives members on select plans more ways to use their allowances for everyday health needs. Depending on the plan and eligibility, allowances may cover over-the-counter items, healthy foods, vision, hearing, fitness, herbal supplements, utilities and weight management. Members in SCAN Baekse and SCAN Ansim Care can use FlexEssentials for an expanded range of eligible needs, including OTC items, fitness, dental, vision, hearing and healthy foods. Benefits built around Costco and Walmart. New Costco and Walmart plans bring added convenience to everyday benefits. Costco members can use their FlexEssentials card for eligible OTC and healthy food, vision and hearing expenses, while Walmart plans include eligible OTC and healthy food and vision expenses. Select plans also include transportation to Costco or Walmart preferred pharmacies, making it easier to see their vision providers at Costco/Walmart or hearing providers at Costco. More support for healthy weight management. Members of SCAN Inspired can use their FlexEssentials benefit for eligible weight-management programs, in addition to OTC items. More personalized support for LGBTQ+ members. SCAN Inclusive offers dedicated care navigation to help LGBTQ+ older adults access affirming care, lifestyle support, peer groups, resources and advocacy. Select eligible members can also receive approved non-medical transportation and up to $200 toward legal-document expenses. More help for caregivers and everyday needs. SCAN Ansim Care includes up to 80 hours of in-home care (caregiver support) designed to provide additional help beyond traditional medical care. Get rewarded for healthy choices. With Health Action Rewards, members on select plans can earn rewards for taking steps to stay healthy - from getting an Annual Wellness Visit and recommended vaccines to completing preventive care and staying physically active. Rewards can be used for eligible items such as healthy foods, OTC products, personal care and fitness items. Depending on the plan, members have different opportunities to earn healthy rewards. Costco members can earn up to $130 per year, while select Walmart, Allied, Connections, Connections at Home, and other eligible plans offer up to $125 per year. DaVita plan members can earn $75-$100 per month, depending on the plan. More support to help you stay independent at home. Depending on the plan and eligibility, at-home support through The Helper Bees may include help with daily activities, companionship, respite care for family caregivers, home-delivered meals, home safety assessments and services or products designed to make the home safer and more comfortable. New locations. More places to choose SCAN SCAN is growing again in 2027, adding five new counties to its service area: Sonoma County, California; Chambers County, Texas; and Liberty County, Texas. The Oregon expansion marks a new state for SCAN, with institutional special needs plans available in Clackamas and Washington counties. SCAN is also expanding existing partnerships within its current footprint. Sutter Health grows into additional Northern California markets, including San Francisco, San Mateo, Santa Clara and Sonoma counties.
SCAN Health Plan, a leading not-for-profit Medicare Advantage plan serving nearly 460,000 members, has appointed Dr Gabriel Waterman as Chief Clinical Officer. In this role, Waterman will advance SCAN's clinical strategy and shift the organisation towards greater ownership of clinical outcomes for members. One of Waterman's initial priorities is ensuring every SCAN member has an upcoming appointment with a primary care provider. He will oversee clinical programs, the Clinical Center of Excellence, and the deployment of SCAN's physicians, nurse practitioners, and clinical pharmacists to support high-risk members. Waterman previously led SCAN Embrace, the organisation's Institutional Special Needs Plan, now the largest in California and Arizona. He brings experience from CareMore Health and holds medical and business degrees from the University of Southern California.
Walmart and Scan to launch co-branded Medicare Advantage plan. The companies will connect the offering with Walmart's broad range of health and wellness products and services and its technology capabilities. September 16, 2026. 2:10 PM BENTONVILLE, Ark. - Walmart and nonprofit insurer Scan Health Plan are introducing a co-branded Medicare Advantage plan in two states. The plan is expected to be available to more than 2 million Medicare enrollees. As part of the collaboration, Scan and Walmart will connect the co-branded Medicare Advantage offering more closely with Walmart's broad range of health and wellness products and services, as well as its technology capabilities. Offerings may include, pending regulatory review and approval, pharmacy and vision services, food and over-the-counter drug benefits. Together, the organizations aim to create a more connected experience that helps older adults navigate their health and wellness needs both inside and outside the doctor's office. The joint venture follows Scan's partnership with Costco Wholesale Corp to launch Costco-branded Medicare Advantage plans. Walmart brings to the collaboration Everyday Health Signals, an AI-powered platform it built to support personalized nutrition and wellness experiences for customers. Everyday Health Signals allows participants to share a wellness goal and receive personalized health and wellness insights, including tailored nutrition information and food recommendations informed by their wellness goals and shopping preferences. SCAN and Walmart plan to make these capabilities available to participating members as part of broader coaching and wellness support, helping members turn personalized nutrition insights into action as they make everyday shopping decisions about what to put on their tables. "At SCAN, we believe healthcare is better when it is personalized to the individual, and when members choose to opt in, data can help us deliver a more relevant experience tailored to their needs," said national general manager Zack Myers. "By combining Walmart's technology capabilities and consumer retail expertise with SCAN's Medicare product experience, we have an opportunity to develop products that translate those insights into meaningful support that helps members make more informed choices about their health and well-being." "Walmart has been helping customers navigate Medicare choices for more than a decade," said Dr. Pravene Nath, group director for consumer health and data solutions at Walmart U.S. "What makes this collaboration unique is Walmart's role in customers' everyday lives. Because customers regularly turn to Walmart for groceries and other everyday essentials, we have an opportunity for those who choose to participate, to use insights from their shopping experiences to make nutrition guidance more relevant and actionable. Combined with Walmart's breadth across food, pharmacy, vision and other health and wellness services, and Scan's deep Medicare expertise, we can create a more connected experience that helps older adults take action on their health goals as part of their everyday routines." The collaboration brings together Scan's nearly five decades of experience serving older adults with Walmart's longstanding experience helping customers navigate Medicare coverage, including more than a decade of in-store insurance support and Walmart Insurance Services, which launched in 2020 as the retailer's licensed insurance agency. Together, Scan and Walmart aim to create a more connected Medicare Advantage experience that supports members across their everyday health and wellness needs. Get the latest Chain Drug Review news delivered straight to your inbox. Have news to share? Send Chain Drug Review your press releases and announcements.
Walmart and SCAN Health Plan announced a partnership to offer co-branded Medicare Advantage plans in two states, targeting over two million Medicare enrollees. The plans, pending regulatory approval, may include pharmacy, vision, food, and over-the-counter benefits. A central feature is Walmart's Everyday Health Signals platform, an AI tool providing personalised nutrition and wellness guidance based on members' shopping preferences and self-reported goals. Walmart launched its licensed insurance agency in 2020. SCAN Group is a nonprofit organisation serving nearly 460,000 members across six states. The deal follows a similar partnership between SCAN and Costco Wholesale to sell Costco-branded Medicare plans. The companies did not disclose financial terms.