Product Manager / Senior Product Manager, Actuarial Analytics & MedInsight Data Products Cambia Health Solutions IncProduct Manager / Senior Product Manager, Actuarial Analytics & MedInsight Data ProductsCoeur d'Alene, ID$100,000–$135,000 / yearHealthcare payer, MedInsight, and actuarial analytics fluency - hands-on experience with payer data domains including claims, eligibility/enrollment, member exposure, provider, product/benefit, revenue, and analytic consumption patterns, with working knowledge of MedInsight or adjacent payer analytics concepts such as PMPM, PkPMY, member months, unit cost, completion factors, benchmarking, trend, utilization, risk adjustment, attribution, population definitions, episode/grouping logic, and fit-for-purpose analytic validation. This is a role for a collaborative data and analytics practitioner who understands healthcare data, can translate actuarial and analytic needs into clear product direction, and is passionate about building a real data, semantics, and agentic stack on a modern data platform that is usable and consumable across the enterprise - deep in the technology as a practitioner, and senior enough to understand and move the business.
Assistant Director Payment Integrity Policy & Implementation Cambia Health Solutions IncAssistant Director Payment Integrity Policy & ImplementationSpokane, WAThese activities include services pertaining to: Correct coding and reimbursement reviews/methodologies, Policy assessment and development, lead Reimbursement Policy Committee, consultation of system wide implementation of payment policies, establish an ongoing ideation and PI initiative development team, act as a key stakeholder in trend management, direct coding disputes team, and strategies on optimization of payment edits and rules across all internal and vendor supported applications - all in service of creating a person-focused health care experience. What You Will Do at Cambia: Lead strategic planning and execution of reimbursement policy, coding disputes, and Payment Integrity ideation initiatives, including program tracking, financial justification, and prioritization in collaboration with Healthcare and Clinical Services leadership, legal, and healthcare informatics.
Temporary Customer Service Professional I Cambia Health Solutions IncTemporary Customer Service Professional IMedford, ORRemote$19–$22.25 / hour6 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.
Software Development Engineer I - III Cambia Health Solutions IncSoftware Development Engineer I - IIIPortland, OR$72,000–$96,000 / yearWorking knowledge of the Salesforce security model, including profiles, permission sets, org-wide defaults (OWD), role hierarchies and sharing rules; able to configure and troubleshoot data visibility issues with guidance or independently depending on complexity. What You Bring to Cambia: Qualifications: The Software Development Engineer I would have a Bachelor's degree in Computer Science, Mathematics, Business Administration, Engineering, or a related field and relevant experience in a multi-platform environment, including, but not limited to application development or database development.
Membership Administrator I Cambia Health Solutions IncMembership Administrator IMedford, ORRemoteAs a member of the Membership team, our Membership Administrators establish and maintain eligibility, bill premiums, reconcile discrepancies, pursue aged accounts, and provide customer service for Individual, Group, Government Programs, COBRA, and Flexible Spending business - all in service of creating an economically sustainable health care system. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.
Manager Cost Accounting Cambia Health Solutions IncManager Cost AccountingBurlington, WADrives change activities through the entire department that improves Cost Accountings ability to meet the current and future demands of our customers, including but not limited to; shorter turn time on month-end close/budget/forecast, enhanced/simplified business reporting, bench marking with other health plans, etc. Is clearly viewed by our customers as a subject matter expert in all areas of Cost Allocations and proactively consults with both internal and external customers and other areas of the company in resolving issues, in process improvement activities and in educating on cost allocation policies and methodology.
Assistant Director Payment Integrity Policy & Implementation Cambia Health Solutions IncAssistant Director Payment Integrity Policy & ImplementationBurlington, WAThese activities include services pertaining to: Correct coding and reimbursement reviews/methodologies, Policy assessment and development, lead Reimbursement Policy Committee, consultation of system wide implementation of payment policies, establish an ongoing ideation and PI initiative development team, act as a key stakeholder in trend management, direct coding disputes team, and strategies on optimization of payment edits and rules across all internal and vendor supported applications - all in service of creating a person-focused health care experience. What You Will Do at Cambia: Lead strategic planning and execution of reimbursement policy, coding disputes, and Payment Integrity ideation initiatives, including program tracking, financial justification, and prioritization in collaboration with Healthcare and Clinical Services leadership, legal, and healthcare informatics.
Clinical Inpatient Pharmacy Technician - Audit & Review Cambia Health Solutions IncClinical Inpatient Pharmacy Technician - Audit & ReviewRemoteAs a member of the Post Service Claim Review team, our Clinical Inpatient Pharmacy Technicians conducts post-service audits to ensure billing accuracy, analyzes billings for consistency with medical records and reimbursement policies, and performs projects as requested by supervisors - all in service of making our members' health journeys easier. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.
Enrollment & Forecasting Analyst or Senior Cambia Health Solutions IncEnrollment & Forecasting Analyst or SeniorRenton, WA$73,231.73–$99,078.23 / yearCustomer Service, Provider Services, Finance, Regulatory Affairs, Underwriting, Strategic Communications, Product Development, Legal, Marketing, Executives) as well as external customers (Brokers/Agents, State Regulators, BCBSA, DHS companies). What You Bring to Cambia: Qualifications: The Enrollment/Product Forecast Analyst would have a Bachelor's degree in mathematics, computer science, business administration or an equivalent related field and 3+ years job-related experience or equivalent combination of education and related work experience.
Temporary Customer Service Professional I Cambia Health Solutions IncTemporary Customer Service Professional IVancouver, WARemote$19–$22.25 / hour6 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.
QA Risk ADj Auditor II Cambia Health Solutions IncQA Risk ADj Auditor IIBoise, ID$26.03–$41.65 / hourIdentifies trends in provider coding/documentation and vendor risk adjustment reporting and makes those trends known to leadership as well as coding team manager and training lead to develop intervention strategies - all in service of creating a person-focused health care experience. As a member of the Risk Adjustment team, our The Risk Adjustment Auditor performs Retrospective/Prospective chart review utilizing various types of records to ensure accurate risk adjustment reporting.
Remote Care Management Nurse Cambia Health Solutions IncRemote Care Management NurseBurlington, WARemote$36.80–$49.80 / hourAs 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. Collaborates with physician advisors, internal and external customers, and other departments to resolve claims, quality of care, member or provider issues, and identifies problems or needed changes, recommending resolutions and participating in quality improvement efforts.
Clinical Inpatient Pharmacy Technician - Audit & Review Cambia Health Solutions IncClinical Inpatient Pharmacy Technician - Audit & ReviewTacoma, WARemoteAs a member of the Post Service Claim Review team, our Clinical Inpatient Pharmacy Technicians conducts post-service audits to ensure billing accuracy, analyzes billings for consistency with medical records and reimbursement policies, and performs projects as requested by supervisors - all in service of making our members' health journeys easier. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.
Software Development Engineer II - III (EDI Enrollment) Cambia Health Solutions IncSoftware Development Engineer II - III (EDI Enrollment)Vancouver, WA$81,000–$106,000 / yearWhat You Bring to Cambia: Qualifications: The Software Development Engineer II would have a Bachelor's degree in Computer Science, Mathematics, Business Administration, Engineering, or a related field and at least 3 years relevant experience in a multi-platform environment. The Software Development Engineer III would have a Bachelor's degree in Computer Science, Mathematics, Business Administration, Engineering, or a related field and at least 5 years relevant experience in a multi-platform environment.
Membership Administrator I Cambia Health Solutions IncMembership Administrator IPortland, ORRemoteAs a member of the Membership team, our Membership Administrators establish and maintain eligibility, bill premiums, reconcile discrepancies, pursue aged accounts, and provide customer service for Individual, Group, Government Programs, COBRA, and Flexible Spending business - all in service of creating an economically sustainable health care system. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.
Membership Administrator I Cambia Health Solutions IncMembership Administrator ISalt Lake City, UTRemoteAs a member of the Membership team, our Membership Administrators establish and maintain eligibility, bill premiums, reconcile discrepancies, pursue aged accounts, and provide customer service for Individual, Group, Government Programs, COBRA, and Flexible Spending business - all in service of creating an economically sustainable health care system. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.
Software Development Engineer III Cambia Health Solutions IncSoftware Development Engineer IIIMedford, OR$90,000–$119,000 / yearQualifications and Certifications: The Software Development Engineer III would have a Bachelor's degree in Computer Science, Mathematics, Business Administration, Engineering, or a related field and at least 5 years relevant experience in a multi-platform environment. Able to lead multi-discipline teams for work efforts including estimating, coordinating, tracking progress, inspiring others to complete tasks on time, assisting with resolving issues, and providing status.
Membership Administrator I Cambia Health Solutions IncMembership Administrator IBurlington, WARemoteAs a member of the Membership team, our Membership Administrators establish and maintain eligibility, bill premiums, reconcile discrepancies, pursue aged accounts, and provide customer service for Individual, Group, Government Programs, COBRA, and Flexible Spending business - all in service of creating an economically sustainable health care system. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.
Manager Cost Accounting Cambia Health Solutions IncManager Cost AccountingFargo, NDDrives change activities through the entire department that improves Cost Accountings ability to meet the current and future demands of our customers, including but not limited to; shorter turn time on month-end close/budget/forecast, enhanced/simplified business reporting, bench marking with other health plans, etc. Is clearly viewed by our customers as a subject matter expert in all areas of Cost Allocations and proactively consults with both internal and external customers and other areas of the company in resolving issues, in process improvement activities and in educating on cost allocation policies and methodology.
Provider Reimbursement Systems Analyst or Sr DOE Cambia Health Solutions IncProvider Reimbursement Systems Analyst or Sr DOEBurlington, WA$72,523–$119,663 / yearAs a member of the Tech Services team, our Provider Reimbursement Systems Analysts support, maintain, and enhance existing systems while developing, configuring, and delivering new solutions in direct alignment with Cambia Core Strategies and Key Initiatives - all in service of creating an economically sustainable health care system. What You Bring to Cambia: Qualifications: Provider Reimbursement Systems Analyst: College degree in Computer Sciences, Mathematics, Business Administration, or a related field; may be substituted by sufficient years of healthcare industry experience.