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. As part of 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. This role involves providing reports, feedback, and recommendations for quality improvement to management, all aimed at creating 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 is $20.50 - $30.80 an hour; full salary range is $19.20 - $34.90 an hour; 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; 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; 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.

Schedule

This role offers work from home options for employees located in Oregon, Washington, Idaho, or Utah. To take advantage of this flexible option, employees must have:

• 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.

As part of our security requirements, new hires will need 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, a competitive salary, and generous benefits while doing work that changes lives. We encourage career growth, community outreach through supported programs, and connecting with colleagues through employee resource groups.