Claims analyst - Urgent Hire

We are searching for a motivated Claims analyst to join our energetic team at Cambia Health Solutions, Inc in Coeur D Alene, ID.
Growing your career as a Full Time Claims analyst is a terrific opportunity to develop exceptional skills.
If you are strong in teamwork, research and have the right personality for the job, then apply for the position of Claims analyst at Cambia Health Solutions, Inc today!

Remote from WA, OR, ID, or UT Primary Job Purpose Claims Investigation Analyst III process a variety of claim types and Customer Service tasks to maintain the complete claims processing cycle for multiple functions/edits. Conducts in-depth research into complex and specialized claims processing. Monitors the accuracy of claims submitted for processing, conducts review of claims in prepayment, and post payment audit to ensure appropriate payment claims. Develops reports by compiling claims processing data for management review. Performs multiple functions involving all Claims payment, Appeals, Vendor Audits, Processing Aids, Training, Payment Validation and Customer Services tasks submitted to Payment Integrity Department. Conducts analysis of findings and provides reports, feedback, and recommendations to internal and external business partners. General Functions and Outcomes

• Makes informed decisions regarding the disposition of claims; may include payment or denial of claims, or requests for further information for all lines of business within Cambia.
• Organize, maintain and keep readily accessible, all references, documents, policies and procedures to ensure correct application of contract benefits.
• Perform at a high-level to ensure quality standards.
• Perform work in an orderly fashion and provide clear audit trails so others can easily complete work in case absence.
• Validate provider and service information. May contact insurance companies, group administrators, providers, agents/brokers, subscribers and other member representatives to obtain missing or incomplete information.
• Maintain confidentiality in all aspects of claims processing, including correspondence and contacts.
• Comply with MTM and Consortium standards as they relate to the employee’s responsibility to meet BlueCross BlueShield Association (BCBSA) standards and corporate goals.
• Identifies the need for and provide feedback for system(s) improvements.
• May assist in division quality monitoring, projects, test analysis and trend analysis as directed by supervisor.
• Update and assist in developing documentation for claim processing.
• Manages Facets tasks workflow
• Monitor and interpret reports for inventory issues and claims processing data as directed by supervisor and/or manager.
• Represent Payment Integrity on a variety of workgroups/projects throughout Cambia. Use claims processing expertise and experience to propose ideas and implement new procedures or guidelines.
• May be asked to provide training and/or auditing support.
• Reviews simple claims to ensure proper coding and payment using department policies and procedures, reimbursement policy, and provider and member contract material. Interprets claim history, medical records and pre-authorization determinations as needed to support review.
• Review provider/member contracts and reimbursement policies.
• Make decisions regarding the disposition of claims; may include payment/denial of claim or request for further medical review, SIU, or bench marketing.
• Process post-payment to pre-payment claim types for vendors and internal resources.
• Work with outside vendors to analyzes and manage claims data such as – new audit concepts, claim adjustments and processing feedback.
• Process post-pay internal large claims adjustments.
• Uses in depth analysis and validation of data to identify root cause of incorrect claims payments, inconsistencies or ambiguities in manuals, policies and guidelines.
• Completes special projects as requested to assist the department.
• Reviews medium/moderate claims to ensure proper coding and payment using department policies and procedures, reimbursement policy, and provider and member contract material.
• Develop post-payment to pre-payment solutions utilizing vendor and internal resources.
• Handle Provider appeals based on vendor decisions.
• Respond to request for trending data on a variety of topics or issues.
• Project Management including meeting deadlines and goals as related to each project including tracking results.
• Support initiatives to modify existing policies, procedures and forms as CMS requires.
• Independently identifies process improvement opportunities, conducts extensive cost-savings analysis, develop plans of action, implements plan, analyses of results and money saved.

Minimum Requirements

• Demonstrates a high degree of ability to learn and retain information in multiple processing systems.
• Strong attention to detail, ability to apply critical thinking/problem solving and consistent high quality of work.
• Fluent with all health insurance claims processing with proven ability to pull, validate, and analyze health insurance claims data.
• Ability to work independently with minimal supervision and as a member of a team.
• Demonstrates understanding of medical terminology and ICD-10/CPT coding
• Excellent interpersonal skills and communication skills both orally and in writing including to ability to be clear and concise when communicating all levels of internal and external stakeholders.
• Proficient in health insurance data systems, Facets, MS Word, Excel, or other comparable programs.
• Ability to work under pressure and meet deadlines by being adaptable to prioritize workload.
• Ability to effectively create and deliver effective presentations for external and internal stakeholders.
• Demonstrates a high degree of job knowledge on multiple complex or specialized claim types.
• Ability to understand impacts of actions on the future state in claims and applicable stakeholders.
• Ability to exercise good judgment and proven analytical skills as well as contribute to the overall effectiveness and progression of the team while remaining agile and adaptable to constant change.
• Ability to create reports for management.
• Strong organizational skills with a demonstrated ability to prioritize and develop multiple projects within varied time constraints.
• Demonstrated analytic skills, developing reports and analyzing results
• Analytical ability in identifying problems, developing solutions and implementing a course of action.
• Detailed understanding of member and/or provider contracts and product offerings.

Normally to be proficient in the competencies listed above Claims Investigation Analyst III would have a High school diploma or equivalent and 5 years of experience in claims processing, plus an additional 2 years in Payment Integrity or Audit or equivalent combination of education and experience. Work Environment

• Extended periods of sitting and telephonic activities may be required.

Depending on candidate's experience and geographical location: The hourly range for this role is $21.85 - $36.85. The bonus target for this position is 5% Some Highlights 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.

• 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 View email address on jobs.institutedata.com. 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.

Benefits of working as a Claims analyst in Coeur D Alene, ID:

● Company offers great benefits
● Rapid Progression
● Competitive salary

● Remote Work opportunity