Cambia Health Solutions Jobs in the United States
Cambia Health Solutions
Yakima, WA
6 months of customer service call center experience; or 6 months of customer service experience in insurance, retail, banking, hospital, medical office or similar industry with extensive customer contact; or equivalent combination of education and experience. (At Cambia, you'll always get help when you need it.) In exchange for your excellent customer care, we provide competitive pay, career growth opportunities, a generous benefits package, and flexible and remote options to help you balance priorities in and outside of work.
Cambia Health Solutions
Burlington, WA
What You Bring to Cambia: Qualifications: Producer Relations Administrator II would have a Bachelor's Degree in business or related field preferred and 7 years of experience in healthcare administration, sales or project management or equivalent combination of education and experience. As a member of the Stop Loss team, we are Responsible for all producer relations activities which includes responding to agent questions and optimizing the agent experience with Cambia - all in service of creating a person-focused health care experience.
Cambia Health Solutions
Yakima, WA
As a member of the Clinical Services team, our Care Management RN's provide clinical care management (such as case management, disease management, and/or care coordination) to best meet the member's specific healthcare needs and to promote quality and cost-effective outcomes. * Must have at least one of the following: Bachelor's degree (or higher) in a health or human services-related field (psychiatric RN or Masters' degree in Behavioral Health preferred for behavioral health); or Registered nurse (RN) license (must have a current unrestricted RN license for medical care management).
Cambia Health Solutions
Tacoma, WA
As a member of the Strategic Finance team, our The Strategic Financial Analyst Lead serves as a trusted finance business partner in the area(s) of support, by providing financial guidance and support; builds budgets, forecasts, conducts variance analysis and reporting; prepares financial analysis and support such as cost-benefit, return on investment and capital resource analysis for new business opportunities, proposals, contracts, or product development; supports cost savings and process improvement efforts; provides financial governance and oversight. * Develops complex financial models and analysis using advanced analytical techniques and financial systems; provides business with solid alternatives to broad, complex and unusual issues; readily modifies or adjusts techniques to meet new situations.
Cambia Health Solutions
Renton, WA
As a member of the Washington Sales Team, our Associate Director Account Management leads a sales team focused on serving our employer customers, analyzing market data and developing strategies to grow our existing customers, while coaching staff on renewals, account management, and solution selling to retain and expand enrollment. The position requires building strong internal and external relationships, representing the company in the community, and driving account strategy with effective execution and market presence across the team, creating a person-focused health care experience.
Cambia Health Solutions
Everett, WA
Ability to lead small teams (3-5) for complex work efforts which includes estimating, coordinating, tracking progress, inspiring others to complete tasks on time, assisting with resolving issues and creating status reports. * Ability to create simple story cards and understand simple acceptance criteria enough to verify results; develop simple technical documentation and understand technical documentation and concepts.
Cambia Health Solutions
Olympia, WA
As a member of the Strategic Finance team, our The Strategic Financial Analyst Lead serves as a trusted finance business partner in the area(s) of support, by providing financial guidance and support; builds budgets, forecasts, conducts variance analysis and reporting; prepares financial analysis and support such as cost-benefit, return on investment and capital resource analysis for new business opportunities, proposals, contracts, or product development; supports cost savings and process improvement efforts; provides financial governance and oversight. * Develops complex financial models and analysis using advanced analytical techniques and financial systems; provides business with solid alternatives to broad, complex and unusual issues; readily modifies or adjusts techniques to meet new situations.
Cambia Health Solutions
Renton, WA
6 months of customer service call center experience; or 6 months of customer service experience in insurance, retail, banking, hospital, medical office or similar industry with extensive customer contact; or equivalent combination of education and experience. (At Cambia, you'll always get help when you need it.) In exchange for your excellent customer care, we provide competitive pay, career growth opportunities, a generous benefits package, and flexible and remote options to help you balance priorities in and outside of work.
Cambia Health Solutions
Tacoma, WA
Payment Integrity Clinician I conducts post service review of claims in prepayment, post payment or audit capacity to ensure appropriate clinical review, reimbursement of claims and accuracy of coding. * Excellent computer skills and proficiency working software programs (i.e. Microsoft Word, Excel, and PowerPoint); learn new processes and systems quickly.
Cambia Health Solutions
Newcastle, WA
What You Bring to Cambia: Qualifications: Market Insights Analyst I: Bachelor's Degree in Economics, Marketing, and/or Business, with two years of experience in analytic disciplines such as competitive analysis, market research, industry trends, data modeling, and trend analysis or equivalent combination of education and job related experience. Market Insights Analyst IV: Bachelor's Degree in Economics, Marketing, and/or Business, with seven years of experience in analytic disciplines such as competitive analysis, market research, industry trends, data modeling, and trend analysis or equivalent combination of education and job related experience.
Cambia Health Solutions
Vancouver, WA
As a member of the Payment Integrity and Claims Operations team, our Administrative Assistants provide centralized operational support for 4 Associate Directors, 2 Directors, and multiple managers and supervisors, handling meeting coordination, document preparation, communication management, and expense tracking. What You Will Do at Cambia: * Provide complex administrative and confidential support including document preparation, proofreading, correspondence management, and screening communications for multiple senior leaders.
Cambia Health Solutions
Burlington, WA
As a member of the Actuarial Risk Adjustment team, you will contribute to the achievement of organizational goals at the team, department, or function level through the management of multiple (often changing) objectives that span multiple domain areas (ex., project management, program management, data analysis, process improvement, business process analysis, communications & change management, etc.). What You Bring to Cambia: Qualifications: Business Operations Specialist would have a Bachelor's degree in Business Administration, Operations Research, Computer Science or related field and 3+ years of experience in business operations, data analysis, or a related field or equivalent combination of education and experience.
Cambia Health Solutions
Spokane, WA
In addition to the registered pharmacist license, successful completion of a pharmacy residency, or advanced degree in health-related field preferred with four years of experience in a clinical ambulatory care/hospital setting, or equivalent experience and at least three years' experience with pharmacy sales, business development or pharmacy benefit management or an equivalent combination of education and experience. Assists the Pharmacy Sales and Account Management Team in planning, developing, and implementing clinical strategies for Pharmacy clients with respect to formulary management, drug utilization management, medication therapy management programs, quality initiatives and drug information and education - all in service of making our members' health journeys easier.
Cambia Health Solutions
Ahtanum, WA
Every day, Cambia's dedicated Customer Service Professionals (CSPs) serve as the face of our company-acting as listeners, problem-solvers, investigators, and advocates who bridge the gap between Cambia and those we serve by answering calls, providing guidance on benefits, claims and eligibility, and making health journeys easier for our members. * 6 months of customer service call center experience; or 6 months of customer service experience in insurance, retail, banking, hospital, medical office or similar industry with extensive customer contact; or equivalent combination of education and experience.
Cambia Health Solutions
Renton, WA
We're seeking a skilled Data and Analytics Engineer with significant experience engineering semantic layers to design, implement, expand and enhance our existing semantic layer within our Snowflake data platform to support AI-driven semantic intelligence and BI for our health insurance payer organization. * Collaboration: Work with data product owners, business analysts, the semantic data architect, data modelers, and data engineers to create and refine data models and troubleshoot issues in production environments.
Cambia Health Solutions
Bellevue, WA
As a member of the Pharmacy Services team, our Clinical Pharmacist Consultants provide professional and clinical pharmacy expertise in making or guiding clinical decisions based on best practices by creating and applying evidence-based medicine evaluations to determine the best quality medication choices that represent the best value in efficacy, safety and affordability. coverage policies, formulary monographs and class reviews, cross-functional projects, and/or initiatives related to the provision of pharmacy benefits that impact safety, quality and affordability - all in service of creating a person-focused health care experience.
Cambia Health Solutions
Tacoma, WA
In addition to the registered pharmacist license, successful completion of a pharmacy residency, or advanced degree in health-related field preferred with four years of experience in a clinical ambulatory care/hospital setting, or equivalent experience and at least three years' experience with pharmacy sales, business development or pharmacy benefit management or an equivalent combination of education and experience. Assists the Pharmacy Sales and Account Management Team in planning, developing, and implementing clinical strategies for Pharmacy clients with respect to formulary management, drug utilization management, medication therapy management programs, quality initiatives and drug information and education - all in service of making our members' health journeys easier.
Cambia Health Solutions
Spokane, WA
6 months of customer service call center experience; or 6 months of customer service experience in insurance, retail, banking, hospital, medical office or similar industry with extensive customer contact; or equivalent combination of education and experience. As the face of Cambia, our CSPs play multiple roles - listener, problem-solver, investigator and advocate - all in service of making our members' health journeys easier and days brighter.
Cambia Health Solutions
Spokane, WA
Every day, Cambia's dedicated Customer Service Professionals (CSPs) serve as the face of our company-acting as listeners, problem-solvers, investigators, and advocates who bridge the gap between Cambia and those we serve by answering calls, providing guidance on benefits, claims and eligibility, and making health journeys easier for our members. * 6 months of customer service call center experience; or 6 months of customer service experience in insurance, retail, banking, hospital, medical office or similar industry with extensive customer contact; or equivalent combination of education and experience.
Cambia Health Solutions
Tacoma, WA
As a member of the Stop Loss team, this position adjudicates all stop loss claims by developing policies and procedures to ensure consistent claim practices and adherence to policy and contract terms, appropriate laws and regulations - all in service of creating a person-focused health care experience. The expected hiring range for a Stop Loss Claims Analyst is $68,900.00 - $93,150.00 depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location.
Cambia Health Solutions
Tacoma, WA
Every day, Cambia's dedicated Customer Service Professionals (CSPs) serve as the face of our company-acting as listeners, problem-solvers, investigators, and advocates who bridge the gap between Cambia and those we serve by answering calls, providing guidance on benefits, claims and eligibility, and making health journeys easier for our members. * 6 months of customer service call center experience; or 6 months of customer service experience in insurance, retail, banking, hospital, medical office or similar industry with extensive customer contact; or equivalent combination of education and experience.
Cambia Health Solutions
Olympia, WA
As a member of the Payment Integrity team, our Assistant Director Claims Production provides leadership for Claims production processing activities in the commercial claims service organization and is responsible for strengthening the organization's effectiveness in claims processing by achieving satisfaction through fast and accurate claims processing - all in service of creating a person-focused health care experience. * 5 years management/supervisory experience with at least 3 years in claims processing, customer service or membership/enrollment or an equivalent combination of education and job-related work experience.
Cambia Health Solutions
Renton, WA
As a member of the Stop Loss team, this position adjudicates all stop loss claims by developing policies and procedures to ensure consistent claim practices and adherence to policy and contract terms, appropriate laws and regulations - all in service of creating a person-focused health care experience. The expected hiring range for a Stop Loss Claims Analyst is $68,900.00 - $93,150.00 depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location.
Cambia Health Solutions
Renton, WA
Possesses strong experience in evaluating and managing multiple complex programs to ensure they achieve business objectives, with advanced knowledge of health insurance industry trends, Commercial and Federal Employee Program (FEP) legislation, regulations and exposure to integrated finance and delivery models as they relate to population health management and improving member health outcomes. Responsible for building trusting relationships between all stakeholders in provider incentive programs and Government Programs teams by understanding each team's vision, strategy and business objectives and establishing credibility as a trusted expert resource to influence positive outcomes - all in service of making our members' health journeys easier.
Cambia Health Solutions
Spokane, WA
The BH UM Clinical Support Specialist does not make clinical decisions, but partners with licensed behavioral health professionals on appropriate actions and responses to support efficient and effective clinical reviews - all in service of creating a person-focused health care experience. Skills and Attributes: * Behavioral health experience in inpatient psychiatric, residential treatment, partial hospitalization, or intensive outpatient settings, with demonstrated knowledge of behavioral health terminology, DSM-5 diagnostic criteria, and coding systems (CPT, DX, HCPCs).
Cambia Health Solutions
Renton, WA
What You Bring to Cambia: Qualifications: * Provider Education Coordinator would have a Bachelor's degree in a related field and at least 5 years of Medicare Advantage or Commercial risk adjustment experience including at least 4 years of experience in a HCC Coding Audit or Network Management role or equivalent combination of education and experience. What You Will Do at Cambia: * Develops, coordinates, and drives risk adjustment education initiatives with network providers and acts as primary point of contact for assigned key provider engagements across Commercial and Medicare lines of business.
Cambia Health Solutions
Newcastle, WA
As a member of the Quality Management team, our Quality Consultant Senior - Health Outcomes Accreditation (HOA) develops, implements and maintains documentation, reporting and interventions in support of HOA. What You Will Do at Cambia: * Develops and maintains comprehensive HOA documentation (work plans, reporting, surveys, policies and procedures) and tracking systems to ensure compliance with regulatory, accreditation, and performance measurement requirements.
Cambia Health Solutions
Yakima, WA
Every day, Cambia's dedicated Customer Service Professionals (CSPs) serve as the face of our company-acting as listeners, problem-solvers, investigators, and advocates who bridge the gap between Cambia and those we serve by answering calls, providing guidance on benefits, claims and eligibility, and making health journeys easier for our members. * 6 months of customer service call center experience; or 6 months of customer service experience in insurance, retail, banking, hospital, medical office or similar industry with extensive customer contact; or equivalent combination of education and experience.
Cambia Health Solutions
Renton, WA
The Technical Project Manager IV handles the largest and most complex of assignments and may lead teams of people to ensure work efforts are delivered on schedule and within budget, while satisfying agreed-upon customer requirements and specifications within the scope of the work effort - all in service of making our members' health journeys easier. * Ability to manage small, less complex work efforts, demonstrated ability to work effectively with minimum supervision and demonstrated ability to work with business sponsors and partners to identify and implement solutions including demonstrated ability to motivate teams to achieve defined deliverables.
Cambia Health Solutions
Spokane, WA
As a member of the Strategic Finance team, our The Strategic Financial Analyst Lead serves as a trusted finance business partner in the area(s) of support, by providing financial guidance and support; builds budgets, forecasts, conducts variance analysis and reporting; prepares financial analysis and support such as cost-benefit, return on investment and capital resource analysis for new business opportunities, proposals, contracts, or product development; supports cost savings and process improvement efforts; provides financial governance and oversight. * Develops complex financial models and analysis using advanced analytical techniques and financial systems; provides business with solid alternatives to broad, complex and unusual issues; readily modifies or adjusts techniques to meet new situations.
Cambia Health Solutions
Burlington, WA
What You Will Do at Cambia: * You'll utilize clinical knowledge and critical thinking to research and review IP UM requests, ensuring completeness of information and taking action to obtain necessary details, while also completing non-clinical tasks to close cases accurately and efficiently. Applying this knowledge to investigate and research complex issues and inquiries related to Inpatient Utilization Management case work, using critical thinking skills and collaborating with clinical staff to resolve them.
Cambia Health Solutions
Newcastle, WA
What You Bring to Cambia: Qualifications: The Director Medicare and Risk Adjustment Strategic Initiatives would have a BA/BS in business management, healthcare administration, finance or relevant field, MBA or MHA preferred, and at least 10 years of executive business strategy, planning, and performance management experience. As a member of the Government Programs team, our The Director Medicare and Risk Adjustment Strategic Initiatives partners with the leadership team to optimize strategic governance, planning and execution in support of day-to-day priorities within the strategic plan.
Cambia Health Solutions
Tacoma, WA
As a member of the Government Programs team, our Program Directors manage the large-scale, complex projects and multiple related initiatives in support of the Medicare Star Ratings Program, providing cross-functional program leadership and strategic planning. Responsible for driving tactical execution of the Star Ratings strategy and program management to ensure work stays on track, quality results are achieved, and the program continually evolves to become a comprehensive, best-in-class program - all in service of making our members' health journeys easier.
Cambia Health Solutions
Vancouver, WA
As a member of the Risk Adjustment team, our Bus Ops Specialists contribute to the achievement of organizational goals at the team, department, or function level through the management of multiple (often changing) objectives that span multiple domain areas (ex., project management, program management, data analysis, process improvement, business process analysis, communications & change management, etc.). What You Bring to Cambia: Qualifications: Business Operations Specialist II would have a Bachelor's degree in Business Administration, Operations Research, Computer Science or related field and 5+ years of experience in business operations, data analysis, or a related field or equivalent combination of education and experience.
Cambia Health Solutions
Yakima, WA
6 months of customer service call center experience; or 6 months of customer service experience in insurance, retail, banking, hospital, medical office or similar industry with extensive customer contact; or equivalent combination of education and experience. As the face of Cambia, our CSPs play multiple roles - listener, problem-solver, investigator and advocate - all in service of making our members' health journeys easier and days brighter.
Cambia Health Solutions
Bellevue, WA
In addition to the registered pharmacist license, successful completion of a pharmacy residency, or advanced degree in health-related field preferred with four years of experience in a clinical ambulatory care/hospital setting, or equivalent experience and at least three years' experience with pharmacy sales, business development or pharmacy benefit management or an equivalent combination of education and experience. Assists the Pharmacy Sales and Account Management Team in planning, developing, and implementing clinical strategies for Pharmacy clients with respect to formulary management, drug utilization management, medication therapy management programs, quality initiatives and drug information and education - all in service of making our members' health journeys easier.
Cambia Health Solutions
Newcastle, WA
The Technical Project Manager IV handles the largest and most complex of assignments and may lead teams of people to ensure work efforts are delivered on schedule and within budget, while satisfying agreed-upon customer requirements and specifications within the scope of the work effort - all in service of making our members' health journeys easier. * Ability to manage small, less complex work efforts, demonstrated ability to work effectively with minimum supervision and demonstrated ability to work with business sponsors and partners to identify and implement solutions including demonstrated ability to motivate teams to achieve defined deliverables.
Cambia Health Solutions
Burlington, WA
As a member of the Strategic Finance team, our The Strategic Financial Analyst Lead serves as a trusted finance business partner in the area(s) of support, by providing financial guidance and support; builds budgets, forecasts, conducts variance analysis and reporting; prepares financial analysis and support such as cost-benefit, return on investment and capital resource analysis for new business opportunities, proposals, contracts, or product development; supports cost savings and process improvement efforts; provides financial governance and oversight. * Develops complex financial models and analysis using advanced analytical techniques and financial systems; provides business with solid alternatives to broad, complex and unusual issues; readily modifies or adjusts techniques to meet new situations.
Cambia Health Solutions
Renton, WA
As a member of the Payment Integrity team, our Assistant Director Claims Production provides leadership for Claims production processing activities in the commercial claims service organization and is responsible for strengthening the organization's effectiveness in claims processing by achieving satisfaction through fast and accurate claims processing - all in service of creating a person-focused health care experience. * 5 years management/supervisory experience with at least 3 years in claims processing, customer service or membership/enrollment or an equivalent combination of education and job-related work experience.
Cambia Health Solutions
Spokane, WA
What You Will Do at Cambia: * You'll utilize clinical knowledge and critical thinking to research and review IP UM requests, ensuring completeness of information and taking action to obtain necessary details, while also completing non-clinical tasks to close cases accurately and efficiently. Applying this knowledge to investigate and research complex issues and inquiries related to Inpatient Utilization Management case work, using critical thinking skills and collaborating with clinical staff to resolve them.
Cambia Health Solutions
Burlington, WA
We're seeking a skilled Data and Analytics Engineer with significant experience engineering semantic layers to design, implement, expand and enhance our existing semantic layer within our Snowflake data platform to support AI-driven semantic intelligence and BI for our health insurance payer organization. * Collaboration: Work with data product owners, business analysts, the semantic data architect, data modelers, and data engineers to create and refine data models and troubleshoot issues in production environments.
Cambia Health Solutions
Vancouver, WA
As a member of the Clinical Services team, our Utilization and Care Management Nurses provide utilization and care management (such as prospective concurrent, retrospective review, post-discharge care coordination) to best meet the member's specific healthcare needs and to promote quality and cost-effective outcomes and appropriate payment for services - all in service of making our members' health journeys easier. * Must have at least one of the following: Bachelor's degree (or higher) in a health or human services-related field (psychiatric RN or Masters' degree in Behavioral Health preferred for behavioral health); or Registered nurse (RN) license (must have a current unrestricted RN license for medical care management).
Cambia Health Solutions
Alger, WA
The Business Systems Analyst Support Services participates in the daily support, maintenance, and enhancement of existing systems, as well as the development, configuration, and delivery of new systems to directly support Cambia Core Strategies and Key Initiatives - all in service of making our members' health journeys easier. Skills and Attributes (Not limited to): * Demonstrated ability to provide leadership in requirements analysis, functional design, quality assurance and implementation activities regarding departmental applications and their associated business processes.
Cambia Health Solutions
Renton, WA
This role involves close collaboration with ML scientists, engineers of all types, and other stakeholders to facilitate the efficient and effective integration of AI models, including machine learning (ML), deep learning (DL), natural language processing (NLP), and generative AI (GenAI), into production environments. The AI Engineer is responsible for designing, implementing, and maintaining AI operations infrastructure to ensure seamless deployment, scalability, and reliability of a wide range of AI applications.
Cambia Health Solutions
Burlington, WA
What You Bring to Cambia: Qualifications: Consulting Research Associate I would have a BA/BS degree in social science, public health, economics, statistics, actuarial science or equivalent related field with less than 3 years of related work experience or equivalent combination of education and experience. Consulting Research Associate II would have a BA/BS degree in social science, public health, economics, statistics, actuarial science or equivalent related field and a minimum of 3 years of related work experience or equivalent combination of education and experience.
Cambia Health Solutions
Spokane, WA
6 months of customer service call center experience; or 6 months of customer service experience in insurance, retail, banking, hospital, medical office or similar industry with extensive customer contact; or equivalent combination of education and experience. As the face of Cambia, our CSPs play multiple roles - listener, problem-solver, investigator and advocate - all in service of making our members' health journeys easier and days brighter.
Cambia Health Solutions
Spokane, WA
Cambia Actuarial and Healthcare Informatics includes over 100 actuaries, consultants, data analysts and statisticians who provide pricing, financial and statistical projections and analysis, risk evaluation, research, and custom reporting for Cambia's health plans and customers in Idaho, Oregon, Utah and Washington and their customers. As a member of the Actuarial and Underwriting team, our the Assistant Actuarial Analyst performs technical, analytical, reporting and support functions, collaborating with peers and management, to help the Cambia Actuarial and Healthcare Informatics departments and the company meet market and financial goals.
Cambia Health Solutions
Bellevue, WA
As a member of the Quality Management team, our Quality Consultant Senior - Health Outcomes Accreditation (HOA) develops, implements and maintains documentation, reporting and interventions in support of HOA. What You Will Do at Cambia: * Develops and maintains comprehensive HOA documentation (work plans, reporting, surveys, policies and procedures) and tracking systems to ensure compliance with regulatory, accreditation, and performance measurement requirements.
Cambia Health Solutions
Tacoma, WA
Every day, Cambia's dedicated Customer Service Professionals (CSPs) serve as the face of our company-acting as listeners, problem-solvers, investigators, and advocates who bridge the gap between Cambia and those we serve by answering calls, providing guidance on benefits, claims and eligibility, and making health journeys easier for our members. * 6 months of customer service call center experience; or 6 months of customer service experience in insurance, retail, banking, hospital, medical office or similar industry with extensive customer contact; or equivalent combination of education and experience.
Cambia Health Solutions
Burlington, WA
As a member of the Clinical Services team, our Care Management RN's provide clinical care management (such as case management, disease management, and/or care coordination) to best meet the member's specific healthcare needs and to promote quality and cost-effective outcomes. * Must have at least one of the following: Bachelor's degree (or higher) in a health or human services-related field (psychiatric RN or Masters' degree in Behavioral Health preferred for behavioral health); or Registered nurse (RN) license (must have a current unrestricted RN license for medical care management).