Performance Integrity Analyst I, II, or III DOE

Cambia Health Solutions, Inc.; Northern (KY); Hybrid; USD 32,000 - 52,000; Full time

Job summary

Cambia Health Solutions, Inc. is seeking a Performance Integrity Analyst I, II, or III to audit claims, enrollment, and customer service for accuracy and timeliness.

The role supports the Federal Employee Program (FEP) Services and Operations, focusing on quality and performance improvements across multiple states and remote work options. The position requires experience in claims, membership, or customer service, with familiarity in Microsoft Office and AI-assisted processes.

Qualifications

• Four years of experience in Claims, Membership or Customer Service or equivalent.
• Audit experience desirable.
• Ability to understand and apply mathematical concepts.
• Proficient PC skills and familiarity with Word, Excel and Outlook.
• Knowledge of claims coding, BlueCard, membership and customer service processes, pricing and provider contract language.
• Experience with AI tools and technologies to enhance productivity and decision-making.

Responsibilities

• Audit claims, enrollment, or customer service activities for accuracy and timeliness according to policies and guidelines.
• Provide feedback on department performance toward service goals.
• Help develop or update department standards.
• Report on performance and identify trends.
• Investigate problems and document inconsistencies in manuals and guidelines.
• Compile performance statistics and generate reports.
• Participate in testing of system changes.

Skills

Audit experience

Claims knowledge

MS Office

AI tools

Tools

Word

Excel

Outlook

Job description

Performance Integrity Analyst I, II, or III DOE Work from home within Oregon, Washington, Idaho or Utah {Also open to current BCBSND employees} 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 Performance Integrity Analysts are living our mission to make health care easier and lives better. As a member of the Federal Employee Program (FEP) Services and Operations team, our Performance Integrity Analyst 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 – all in service of creating a person-focused health care experience. Ready to make a direct impact on federal employees' health care experience while building your analytical career at a mission-driven organization? Want to use your analytical skills to improve health care quality and accuracy for thousands of members while growing with an award-winning team? Then this role may be the perfect fit.

What You Bring to Cambia:

• Four years experience in Claims, Membership or Customer Service, depending on current business need, or equivalent combination of education and job-related experience.
• Audit experience desirable.
• 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 highly desired

What You Will Do at Cambia:

• 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.

Pay and Hiring Ranges:

#LI-Remote Pay ranges vary based on the candidate's work location. The expected hiring range depends on skills, experience, education, and training; relevant licensure / certifications; and performance history.

Performance Integrity Analyst I:

Oregon, Washington, Utah, and Idaho: The expected hiring range is $20.50 - $30.80 an hour, the full salary range is $19.20 - $34.90 an hour and the bonus target is 5%. North Dakota: The expected hiring range is $22.46 - $30.83 an hour and the full salary range is $20.32 - $32.51 an hour.

Performance Integrity Analyst II:

Oregon, Washington, Utah, and Idaho: The expected hiring range is $23.00 - $33.90 an hour, the full salary range is $21.60 - $38.40 an hour and the bonus target is 5%. North Dakota: The expected hiring range is $24.30 - $32.88 an hour and the full salary range is $22.00 - $35.19 an hour.

Performance Integrity Analyst III:

Oregon, Washington, Utah, and Idaho: The expected hiring range is $25.90 - $37.30 an hour, the full salary range is $24.40 - $42.20 an hour and the bonus target is 5%. North Dakota: The expected hiring range is $26.42 - $35.74 an hour and the full salary range is $23.91 - $38.25 an hour.

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.

• 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. If you need accommodation for any part of the application process because of a medical condition or disability, please email [e-mail]. 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.

Interested in driving accessibility, affordability and quality health care for real people?