Performance Integrity Analyst I, II, or III DOE

Cambia Health Solutions • Lewiston, ID

3d • Remote

About The Position

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. Every day, Cambia’s dedicated team of Performance Integrity Analysts are living our mission to make health care easier and lives better. As a member of the Federal Employee Program (FEP) Services and Operations team, our Performance Integrity Analyst will 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 to meet performance and service level goals. Provide reports, feedback and recommendations for quality improvement to management – all in service of creating a person-focused health care experience. Ready to make a direct impact on federal employees' health care experience while building your analytical career at a mission-driven organization? Want to use your analytical skills to improve health care quality and accuracy for thousands of members while growing with an award-winning team? Then this role may be the perfect fit.

Requirements

• Four years experience in Claims, Membership or Customer Service, depending on current business need, or equivalent combination of education and job-related experience.
• Demonstrated proficient PC skills and familiarity with corporate software, such as Word, Excel and Outlook.
• Ability to understand and apply mathematical concepts.

Nice To Haves

• Audit experience desirable.
• Knowledge of claims coding, BlueCard, membership and customer service processes, applicable systems including pricing and provider contract language.
• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

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.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed