Systems/Quality Analyst II-III (EDI Enrollment)

Cambia Health Solutions; Oregon (WI); Hybrid; USD 80,000 - 142,000; Full time

Job summary

Cambia Health Solutions is hiring a Systems/Quality Analyst II-III (EDI Enrollment) in a hybrid role with three days per week in the office. You will join the Data Science & Machine Learning team to analyze business, data, and product requirements for health enrollment systems, including HIPAA EDI processes, data validation, and reporting.

The role requires a degree in CS/Math/Business and 2–5 years of experience in requirements development, with strong SQL and data exchange skills.

Qualifications

• Bachelor's degree in CS, Math, Business Administration or related field.
• Minimum 2 years of business or system experience for II; 5 years for III in developing requirements for projects where software is created.

Responsibilities

• Read and create simple structured specifications such as use cases and story cards.
• Understand design and business models including basic technical understanding.
• Writes SQL queries and reads simple data models.
• Participates as liaison between development and end users.
• Contributes to deliverables including analysis and validation.
• Provide level 1 on-call support as needed.

Education

Bachelor's degree in Computer Science, Mathematics, Business Administration, or a related field

Tools

Edifecs knowledge

Facets enrollment

Job description

Systems/Quality Analyst II-III (EDI Enrollment)

Hybrid role (3 days/week in office) at our Burlington, Renton, Spokane, Vancouver, Portland, Medford, Salt Lake City, Boise, Lewiston, or Fargo offices. Candidates must reside within commutable distance of that location or be willing to relocate. 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 Systems Analysts are living our mission to make health care easier and lives better. As a member of the Data Science & Machine Learning team, the Systems Analyst participates in a team environment for the development, maintenance, and delivery of product/application (s) and data integrations as an integral part of a multi-functional team. This position is generally responsible for business, data and product/application analysis. This position requires business, analytical, design, interpersonal, technical and administrative skills in performing day to day work – all in service of creating a person-focused health care. Do you have a passion for serving others and learning new things? Then this role may be the perfect fit.

Qualifications

The Systems Analyst II would have a Bachelor's degree in Computer Science, Mathematics, Business Administration, or a related field and minimum of 2 years business or system experience developing requirements for projects where computer software is created or the equivalent combination of education and/or experience including experience with methodologies and structured analytical approach. The Systems Analyst III would have a Bachelor's degree in Computer Science, Mathematics, Business Administration, or a related field and minimum of 5 years business or system experience developing requirements for projects where computer software is created or the equivalent combination of education and/or experience including experience with methodologies and structured analytical approach.

Preferred Skills

• HIPAA 834 EDI Enrollment processing
• Healthcare eligibility and membership management
• Facets enrollment and membership systems
• Data analysis, validation, and reconciliation
• SQL and database querying
• ETL and data integration concepts
• XML and file-based data exchanges
• Enrollment error analysis and resolution
• Trading partner and vendor coordination
• Requirements gathering and business process analysis
• Testing support (SIT/UAT) and defect management
• Reporting and data quality assurance

Good to have

• Edifecs knowledge
• Healthcare payer domain experience
• Medicare and Commercial enrollment processes
• Spreadsheet-based data analysis and automation
• Production support and issue triage

Skills and Attributes

• Ability to work with teammates and with business partners to participate in sessions to gather, translate and document and system requirements to support transforming requirements into effective technology solutions.
• Ability to create simple story cards and understand simple acceptance criteria enough to verify results; develop simple technical documentation and understand technical documentation and concepts.
• Ability to coordinate and facilitate one‑to‑one and small groups (3-5) of customers or other analysts for small work efforts.
• Ability to develop positive relationships among business partners, teammates and management.
• Ability to follow direction, collaborate effectively with peers to provide results, and relay status to management and peers in a timely manner.
• Able to plan and manage their own work with minimal supervision.
• Ability to apply critical thinking and listening skills, rigorous logic and other methods to contribute to the solution of problems, looks beyond the obvious, asks probing questions, can see hidden problems, steps up to conflicts.
• Ability to have cleaR&Direct written and verbal communications with others and can encourage and skillfully manage questions.
• Must have exposure and knowledge of common software development methodologies.
• Able to contribute to a QA strategy.
• Experience with AI tools and technologies to enhance productivity and decision‑making in professional settings highly desired

Additional Skills for Level III

• Ability to lead small teams (3-5) for complex work efforts which includes estimating, coordinating, tracking progress, inspiring others to complete tasks on time, assisting with resolving issues and creating status reports.
• Ability to present and effectively communicate with leadership.
• Ability to participate in the definition of a QA plan.
• Ability to use and coach more junior team members and business partners on development methodologies.

What You Will Do at Cambia

• Read and create simple structured specifications such as use cases, story cards.
• Read and understand design and business models including basic technical understanding.
• Writes SQL queries, reads simple data models.
• Understands and participates in the creation of deliverables by acting as a liaison between the development team and the end users.
• Contributes to deliverables including analysis, development that may including writing SQL/scripting, quality and validation.
• Be able to provide level 1 on‑call support as needed which includes application monitoring, issue identification and routing, on‑call support communications.
• Manage tasks on smaller work efforts in support of the software development methodology.
• Actively acquire in depth knowledge of Health Care and Insurance terminology and concepts.
• Provides estimates for small tasks increasing accuracy of the estimate as work effort progresses.
• Additional Responsibilities for Level III: Applies deep health insurance knowledge to create complex specifications (use cases, story cards, business models) and writes advanced SQL queries while training junior analysts.
• Develops automated validation techniques and understands API concepts including structures, JSON, and collections for technical design documentation.
• Reads complex data models, creates logical data models, and provides accurate estimates for complex work efforts throughout project progression.
• Leads medium-sized cross‑departmental groups using structured approaches (JRP, grooming sessions) and manages tasks on moderate enterprise‑wide initiatives.
• Trains and coaches less experienced and peer analysts, and may participate in vendor product research, evaluation, and selection.

Work Environment

Work primarily performed in office environment. Travel may be required, locally or out of state. May be required to work outside normal hours including being on call 7 days per week, 24 hours per day.

Pay ranges vary based on the candidate’s work location

Systems Analyst II: Oregon, Washington, Utah, and Idaho: The expected hiring range is $80,200 - $90,000, the full salary range is $80,200 - $117,000, and the bonus target is 10%. North Dakota: The expected hiring range is $66,000 - $86,000, and the full hiring range is $66,000 - $106,000.

Systems Analyst III: Oregon, Washington, Utah, and Idaho: The expected hiring range is $87,000 - $109,000, the full salary range is $87,000 - $142,000, and the bonus target is 15%. North Dakota: The expected hiring range is $80,000 - $106,000, and the full hiring range is $80,000 - $133,000.

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.

Just a few highlights include

• 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.

Equal Opportunity Employer

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?

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