Performance Integrity Analyst I, II, or III DOE

About the role

Build a career with purpose at Cambia, where Performance Integrity Analysts examine and validate Plan and employee performance according to established policies, procedures, and mandated audit guidelines. In this role within the Federal Employee Program (FEP) Services and Operations team, you will monitor the accuracy and timeliness of claims, membership, and customer service to meet performance and service level goals. You will provide reports, feedback, and recommendations for quality improvement to management, contributing to a person-focused health care experience for federal 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 and 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 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 $20.50 - $30.80/hour; full salary range $19.20 - $34.90/hour; bonus target 5%.
  • North Dakota: Expected hiring range $22.46 - $30.83/hour; full salary range $20.32 - $32.51/hour.
• Performance Integrity Analyst II
  • Oregon, Washington, Utah, and Idaho: Expected hiring range $23.00 - $33.90/hour; full salary range $21.60 - $38.40/hour; bonus target 5%.
  • North Dakota: Expected hiring range $24.30 - $32.88/hour; full salary range $22.00 - $35.19/hour.
• Performance Integrity Analyst III
  • Oregon, Washington, Utah, and Idaho: Expected hiring range $25.90 - $37.30/hour; full salary range $24.40 - $42.20/hour; bonus target 5%.
  • North Dakota: Expected hiring range $26.42 - $35.74/hour; full salary range $23.91 - $38.25/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 leave (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.

Schedule

This role offers work-from-home options for employees located in Oregon, Washington, Idaho, or Utah. Requirements for remote work include:

• A wired internet connection that is not satellite or cellular.
• Internet service with a minimum upload speed of 5Mb and a minimum download speed of 10Mb.
• Access to a personal mobile device to set up Multi-Factor Authentication (MFA) upon joining the company.

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 to transform health care.
• A competitive salary and generous benefits while doing work that changes lives.
• Career growth with a company committed to helping you succeed.
• Opportunities to give back to your community through Cambia-supported outreach programs.
• Employee resource groups to connect with colleagues who share similar interests and backgrounds.