Primary Job Purpose
Position is remote within Oregon, Washington, Utah and Idaho
The Performance Integrity Analyst I 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.
General Functions and Outcomes
- 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.
- Four years experience in Claims, Membership or Customer Service, depending on current business need, or equivalent combination of education and job-related experience.
- 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.
- Audit experience desirable.
- Work overtime and on weekends due to fluctuating workload.
- Sitting and keying for extended periods of time.
This position includes 401(k), healthcare, paid time off, paid holidays, and more. For more information, please visit www.cambiahealth.com/careers/total-rewards
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 CambiaCareers@cambiahealth.com