Performance Integrity Analyst I, II, or III DOE

About the Role

Build a career with purpose as a Performance Integrity Analyst within the Federal Employee Program (FEP) Services and Operations team. In this role, you will examine and validate Plan and employee performance according to established policies, procedures, and mandated audit guidelines. You will monitor the accuracy and timeliness of claims, membership, and customer service to meet performance and service level goals. Additionally, you will provide reports, feedback, and recommendations for quality improvement to management, all in service of creating a person-focused health care experience.

This position is open to remote work within Oregon, Washington, Idaho, or Utah, and is also available to current BCBSND employees.

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 the 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 and identify inconsistencies or ambiguities in manuals, policies, and guidelines.
• Compile performance statistics and identify potential trends.
• Generate reports and participate in testing implemented system changes.

Requirements

Four years of experience in Claims, Membership, or Customer Service, depending on current business need, or an equivalent combination of education and job-related experience. Audit experience is desirable.

Skills

• 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.
• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings is highly desired.

Pay

Pay ranges vary based on the candidate's work location, skills, experience, education, training, relevant licensure/certifications, and performance history.

• Performance Integrity Analyst I
  • Oregon, Washington, Utah, and Idaho: Expected hiring range is $20.50 - $30.80 an hour, full salary range is $19.20 - $34.90 an hour, and the bonus target is 5%.
  • North Dakota: Expected hiring range is $22.46 - $30.83 an hour, full salary range is $20.32 - $32.51 an hour.
• Performance Integrity Analyst II
  • Oregon, Washington, Utah, and Idaho: Expected hiring range is $23.00 - $33.90 an hour, full salary range is $21.60 - $38.40 an hour, and the bonus target is 5%.
  • North Dakota: Expected hiring range is $24.30 - $32.88 an hour, full salary range is $22.00 - $35.19 an hour.
• Performance Integrity Analyst III
  • Oregon, Washington, Utah, and Idaho: Expected hiring range is $25.90 - $37.30 an hour, full salary range is $24.40 - $42.20 an hour, and the bonus target is 5%.
  • North Dakota: Expected hiring range is $26.42 - $35.74 an hour, full salary range is $23.91 - $38.25 an hour.

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.

We offer work from home options for most roles, requiring a wired internet connection with a minimum upload speed of 5Mb and a minimum download speed of 10Mb. New hires will need access to a personal mobile device to set up Multi-Factor Authentication (MFA).

About Cambia

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation with over 100 years of history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Cambia offers opportunities to work alongside diverse teams building cutting-edge solutions, a competitive salary, and generous benefits while doing work that changes lives. We are committed to helping you grow your career and giving back to the community through outreach programs. Employee resource groups are available to connect with colleagues who share similar interests and backgrounds.