Cambia Health Solutions, Inc
Location
Portland, OR | United States
Job description
Remote within WA, ID, OR, and UT - Candidates located outside of Washington, Idaho, Oregon, or Utah will not be considered. Primary Job Purpose
The Claims Analyst is responsible for adjudicating post-service, pre-payment medical (professional, outpatient, and inpatient facility) and dental claims of varying complexity by investigating and editing claims data to ensure claims are processed timely, accurately and in accordance with contractual requirements.
Responsibilities - Investigates and finalizes incoming claims timely, accurately, and in accordance with all applicable policies and guidelines
- Establishes clear and concise documented audit trails for all claims processed
- Adapts to daily changes in workload/responsibilities based upon department/division goals and priorities
- Consistently meets or exceeds department expectations for claims accuracy, timeliness, and productivity
- Maintains confidentiality in all aspects of claims processing, with special emphasis on compliance with HIPAA requirements
- Identifies and reports irregularities or trends in claims processing
- Routinely adapts to and implements new policies, procedures, and company initiatives
- Continually reviews assigned areas of responsibility and gives suggestions on how to streamline or enhance service/processes
- Works independently with minimal direction
Additional Responsibilities For Level II - Processes claims with increasing degrees of complexity
- Effectively communicates basic-moderate claims procedures to achieve understanding for both internal and external customers
- Learns new processes quickly and accurately incorporates them into daily processing
- Completes special projects or reports as assigned to assist in inventory management
- Identifies and provides insight to improve documentation, processes, and/or systems
- Provides support and mentorship to junior Claims Analysts through Q&A, job shadow, observation, and/or audit
Additional Responsibilities For Level III - Processes claims of all degrees of complexity
- Supports escalated and highly visible work as needed
- Effectively communicates complex claims procedures to achieve understanding for both internal and external customers
- Provides support and mentorship to all levels of Claims Analysts through Q&A, job shadow, observation, and/or audit
- Effectively facilitates meetings and training as appropriate
- Demonstrates initiative and participates in workgroups for departmental improvement as needed
- Provides leadership support as needed
Minimum Requirements - Computer experience, including working knowledge of Microsoft Office software, such as MS Word, Outlook, and Excel, or other comparable programs
- Basic math skills
- Keyboarding skills
- Strong attention to detail
- Excellent interpersonal skills
- Communicate effectively orally and in writing
- Work independently as well as a member of a team
- Ability to work under pressure and meet deadlines
- Meet dependability, timeliness, attendance, quantity, and quality standards as established by department
- Provide excellent customer service when communicating with external and internal customers
Additional Minimum Requirements For Level II - Ability to learn new processes quickly and incorporate them into daily processing accurately
- Ability to process claims of increasing complexity
- Exercise sound judgment and decision making based on thorough investigation of facts and critical thinking
- Ability to quickly learn and retain claims processing procedures and guidelines for multiple processing systems
Additional Minimum Requirements For Level III - Ability to process claims of all degrees of complexity
- Demonstrate a strong analytical ability in identifying problems and communicating with department leaders
- Ability to perform in-depth investigation, using mature judgement to develop and implement solutions
Normally To Be Proficient In The Competencies Listed Above - Claims Analyst I would have a high school diploma (or equivalent) and 1 year office experience, preferably in health insurance claims or in a medical office setting, or equivalent combination of education and experience.
- Claims Analyst II would have a high school diploma (or equivalent) and 1-2 years’ experience processing health insurance claims, or equivalent combination of education and experience.
- Claims Analyst III would have a high school diploma (or equivalent) and 3-4 years’ experience processing health insurance claims, or equivalent combination of education and experience.
The base pay hourly range for this job is $17.20-$20.40/hour, depending on candidate's geographic location and experience.
The annual incentive payment target for this position is 5%.
Benefits Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:
- medical, dental, and vision coverage for employees and their eligible family members
- annual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)
- paid time off varying by role and tenure in addition to 10 company holidays
- up to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)
- up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)
- one-time furniture and equipment allowance for employees working from home
- up to $225 in Amazon gift cards for participating in various well-being activities. for a complete list see our External Total Rewards page.
We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.
If you need accommodation for any part of the application process because of a medical condition or disability, please email
[email protected]. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.
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