Performance Integrity Analyst I, II, III

🔥 0 minutes ago

🥔 Idaho, Oregon, +2 more states – Remote

🥔 Idaho – Remote 🌲 Oregon – Remote ⛷️ Utah – Remote ☕ Washington – Remote

💵 $19 - $42 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

👻 Ghost score 0%

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Cambia Health Solutions

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 Non-profit

Healthcare • Healthcare Insurance • Non-profit

Cambia Health Solutions is a nonprofit, mission-driven healthcare company based in Portland, Oregon, that operates consumer-focused health care and health insurance businesses and invests in health innovation. It serves as the parent organization for the Regence family of health plans and runs initiatives and subsidiaries focused on improving care delivery, providing insurance products, and developing digital health tools and services.

📋 Description

• Examine and validate Plan and employee performance according to established policies, procedures and mandated audit guidelines • Monitor accuracy and timeliness of claims, membership and customer service against performance and service-level goals • Provide reports, feedback and recommendations for quality improvement to management • Audit claims, enrollment or customer service activities for accuracy and timeliness • Encourage team and individual contributions toward company quality initiatives • Participate in developing or updating department standards • Provide feedback on department performance against service and performance-level goals • Stay current on applicable departmental 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

🎯 Requirements

• Four years of experience in Claims, Membership or Customer Service, depending on current business need, or equivalent combination of education and job-related experience • Audit experience desirable • Ability to understand and apply mathematical concepts • Proficient PC skills and familiarity with Word, Excel and Outlook • Knowledge of claims coding, BlueCard, membership and customer service processes • Knowledge of applicable systems, including pricing and provider contract language • Experience with AI tools and technologies highly desired • Wired internet connection that is not satellite or cellular, with minimum upload speed of 5Mb and download speed of 10Mb for work-from-home employees • Access to a personal mobile device for MFA • Successful background check • Must work from home within Oregon, Washington, Idaho or Utah

🏖️ Benefits

• Competitive salary • Medical, dental and vision coverage for employees and eligible family members, including mental health benefits • Annual employer contribution to a health savings account • Generous paid time off • 10 company-paid holidays • Market-leading retirement plan with company match on employee 401(k) contributions • Potential discretionary retirement contribution based on company performance, with no vesting period • Up to 12 weeks of paid parental time off after 12 months of continuous service • Award-winning wellness programs that reward participation • Employee Assistance Fund • Commute and parking benefits • Bonus opportunities • Work-from-home options • Employee resource groups • Cambia-supported community outreach programs • Wired internet connection requirement for work-from-home employees • Personal mobile device for Multi-Factor Authentication