Benefit Contrct Anlyst

Cambia Health Solutions; Portland (OR); Hybrid; USD 63,000 - 85,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Paid time off

Work from home options

Retirement plan with 401(k)

Job summary

Cambia Health Solutions seeks a Benefit Contract Analyst to develop and file regulatory benefit materials for members and groups. This role focuses on benefit booklets, contracts, policies, SOBs and SBCs across various plans, ensuring accuracy and compliance.

The ideal candidate holds a bachelor’s degree in healthcare or related field, 3+ years of experience, and a strong understanding of ACA, COBRA and HIPAA. Collaboration with Legal, Product, and Insurance Departments is essential.

Qualifications

• Bachelor's degree and 3 years relevant experience.
• Knowledge of ACA, COBRA, HIPAA and state regulations.
• Experience drafting and filing regulatory documents.

Responsibilities

• Draft and develop benefit language for health insurance products.
• Coordinate with partners to produce benefit booklets, contracts, policies, SBCs and summaries of benefits.
• Ensure documents are compliant, complete and well written.
• Oversee regulatory submissions and track status.
• Maintain relationships with Insurance Department; respond to objections.
• Collaborate with Legal and Product teams.

Skills

Organizational skills

Communication skills

Negotiation

Independence

Health insurance knowledge

AI tools experience

Education

Bachelor's degree in healthcare, English, business or health care administration

Tools

Microsoft Word

Job description

Benefit Contract Analyst Hybrid role (3 days/week in office) at our Portland, Medford, Boise, Lewiston or Salt Lake City offices. Candidates must reside within commutable distance of that location. Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.

Who We Are Looking For:

Every day, Cambia’s dedicated team of Benefit Contract Analysts is living our mission to make health care easier and lives better. As a member of the Benefit Contract team, our Benefit Contract Analyst (BCA) is responsible for the development and filing of regulatory benefit materials for members and groups. These materials include benefit booklets, contracts, policies, schedules of benefits (SOBs) and Summary of Benefits and Coverage (SBCs) for standard individual, small group, and large group, as well as negotiated large group fully underwritten and self-funded plan documents/summary plan descriptions. A BCA develops benefit language, collaborates with Legal and Product, coordinates the filing of regulatory documents with state insurance divisions, analyzes insurance division objections, organizes responses and completes filing resubmission functions – all in service of creating a person-focused health care experience. Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit.

What You Bring to Cambia:

Qualifications: Benefit Contracts Analyst would have a bachelor's degree in healthcare, English, business or health care administration, communications and 3 years work-related experience or equivalent combination of education and experience.

Skills and Attributes:

• Possesses significant organizational skills with a demonstrated ability to prioritize, coordinate and implement multiple projects within varied or simultaneous time constraints and deadlines.
• Coordinates language drafting and document production activities with all levels of staff within the organization and with external agencies through clear and concise verbal and written communication skills, including tactful and persuasive negotiation skills.
• Demonstrated ability to work independently, exercise sound judgment, and develop collaborative and effective working relationships with internal and external business partners, including, but not limited to, Sales, Sales Operations, Product and the Insurance Division.
• Fearlessly takes on new challenges in a changing insurance and corporate environment.
• Comprehends and masters the drafting of all aspects of the regulatory health benefit documents for fully-insured lines of business and custom groups.
• Highly proficient in Windows applications, including Word.
• Comfortable working in high-pressure circumstances, with multiple concurrent projects involving multidisciplinary, distinct tasks, and a proven ability to initiate and independently produce detailed and highly accurate work.
• Must be able to work with minimal supervision and assume increasingly complex responsibilities.
• Exhibits knowledge of the health insurance industry, including benefit design and compliance concerns. This may include an understanding of federal laws and guidelines, such as the Affordable Care Act (ACA), COBRA, HIPAA and state health insurance code and regulations.
• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired.

What You Will Do at Cambia:

Drafting Group and Member Benefit Materials:

• Creates and develops benefit language for new health insurance products, programs and services in response to federal and state regulations and marketplace changes.
• Negotiates and coordinates with internal and external business partners to develop, write, revise, and coordinate group and member benefit booklets, contracts, policies, summaries of benefit coverage, and all other regulatory documents for Individual, Small Group, Large Group, Administrative Services Only, Medicare Supplemental, Dental and Vision plans.
• Ensures that legal documents and contracts are legally compliant, complete, professionally written and understandable.
• Oversees and tracks regulatory submissions.
• Establishes and maintains an effective working relationship with the Insurance Department to ensure timely submission of regulatory compliant form filings, managing them until insurance division approval is received.
• Validates regulatory filings prior to and following the submission with the Insurance Departments in Idaho, Oregon, Utah, and Washington.
• Manages regulatory objections by analyzing insurance division requests, researching options, negotiating response language, and submitting timely replies.

Customer Relationship Management:

• Cultivates and maintains relationships with key internal and cross-divisional teams, as well as external customers, including producers, groups and Insurance Department contacts.
• Researches and responds to requests for interpretation of benefits within the health benefit materials.
• Demonstrates initiative and analytical ability in identifying problems, researching issues, developing solutions, and implementing a course of action.
• Listens and communicates appropriately in a manner that promotes positive, professional interaction while preserving confidentiality and sensitivity in all aspects of internal and external contacts.

Work Environment:

• No unusual working conditions.
• Work primarily performed in office environment.
• Travel may be required, locally or out of state.
• May be required to work overtime.
• May be required to work outside normal hours.

Salary and Location:

Oregon, Utah, and Idaho: The expected hiring range is $62,900.00 – $85,100.00, the full salary range is $59,000.00 – $97,000.00 and the bonus target is 5%.

About Cambia:

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

Why Join the Cambia Team?

At Cambia, you can:

• Work alongside diverse teams building cutting-edge solutions to transform health care.
• Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
• Grow your career with a company committed to helping you succeed.
• Give back to your community by participating in Cambia-supported outreach programs.
• Connect with colleagues who share similar interests and backgrounds through our employee resource groups.

We believe a career at Cambia is more than just a paycheck – and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more. In exchange for helping members live healthy lives, we offer benefits that empower you to do the same.

Benefits Highlights:

• 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.

Learn more about our benefits.

We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.

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. MFA is an important layer of protection for accessing Cambia systems and is required for all employees.

We are an Equal Opportunity employer dedicated to 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.

Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.

Everyone is a health care consumer deserving of a simpler, more personalized experience. Cambia is transforming the health care system to revolve around people. For over 100 years we’ve designed people-first health solutions rooted in the nation’s first health plan, a loggers’ wage pool established in the Pacific Northwest. Today that pioneering spirit aligns our family of over 20 companies, including 4 not-for-profit BlueCross and BlueShield licensed health plans serving over 3 million Americans. Cambia blends data science with a compassionate human perspective to anticipate people’s needs, and empower them to make smarter health care choices.