Note: The job is a remote job and is open to candidates in USA. Cambia Health Solutions is a mission-driven health care organization focused on creating a person-focused and economically sustainable health care system. The Performance Integrity Analyst examines and validates plan and employee performance, monitors claims, membership, and customer service accuracy and timeliness, and provides reporting and recommendations for quality improvement.
Responsibilities
- Audit claims, enrollment, or customer service activities for accuracy and timeliness according to audit policies, procedures and mandated guidelines
- Encourage team and individual contributions toward the company's quality initiatives in improvement efforts
- Participate in team efforts to develop or update department standards
- Provide feedback on department's performance in reaching service and performance level goals
- Remain continuously current on changes and/or additions to all other applicable departments' policies, procedures and guidelines
- Thoroughly investigate problems
- Identify and report inconsistencies or ambiguities in manuals, policies and guidelines
- Compile performance statistics and identify potential trends
- Generate reports
- Participate in testing implemented system changes
Skills
- Four years experience in Claims, Membership or Customer Service, depending on current business need, or equivalent combination of education and job-related experience
- Ability to understand and apply mathematical concepts
- Demonstrated proficient PC skills and familiarity with corporate software, such as Word, Excel and Outlook
- Knowledge of claims coding, BlueCard, membership and customer service processes, applicable systems including pricing and provider contract language
- Audit experience desirable
- Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired
Benefits
- Work from home within Oregon, Washington, Idaho or Utah
- Work alongside diverse teams building cutting-edge solutions to transform health care.
- Grow your career with a company committed to helping you succeed.
- Give back to your community by participating in Cambia-supported outreach programs.
- Connect with colleagues who share similar interests and backgrounds through our employee resource groups.
- Bonus opportunities
- Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
- Annual employer contribution to a health savings account.
- Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
- Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
- Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
- Award-winning wellness programs that reward you for participation.
- Employee Assistance Fund for those in need.
- Commute and parking benefits.
Company Overview