Performance Integrity Analyst I, II, III

This is a fully remote position, open to applicants in Idaho, +3 more states.

📋 Description

• Assess and validate Plan and employee performance in accordance with established policies, procedures, and required audit guidelines.

• Oversee the accuracy and promptness of claims, membership, and customer service in relation to performance and service-level objectives.

• Deliver reports, feedback, and suggestions for quality enhancement to management.

• Conduct audits of claims, enrollment, or customer service activities to ensure accuracy and timeliness.

• Motivate team and individual efforts towards the company's quality initiatives.

• Engage in the development or revision of departmental standards.

• Provide insights on departmental performance relative to service and performance-level objectives.

• Remain updated on relevant departmental policies, procedures, and guidelines.

• Conduct thorough investigations into issues.

• Identify and flag inconsistencies or ambiguities in manuals, policies, and guidelines.

• Compile performance metrics and pinpoint potential trends.

• Produce reports.

• Contribute to the testing of newly implemented system changes.

⛳️ Requirements

• A minimum of four years of experience in Claims, Membership, or Customer Service, depending on current business needs, or a suitable combination of education and job-related experience.

• Experience in auditing is preferred.

• Ability to comprehend and apply mathematical concepts.

• Strong PC skills with proficiency in Word, Excel, and Outlook.

• Familiarity with claims coding, BlueCard, membership, and customer service processes.

• Understanding of relevant systems, including pricing and provider contract terminology.

• Experience with AI tools and technologies is highly desirable.

• A wired internet connection that is not satellite or cellular, with a minimum upload speed of 5Mb and download speed of 10Mb for remote employees.

• Access to a personal mobile device for Multi-Factor Authentication.

• Successful completion of a background check.

• Must reside in Oregon, Washington, Idaho, or Utah while working from home.

🏝️ Benefits

• Competitive salary.

• Medical, dental, and vision coverage for employees and eligible family members, including mental health benefits.

• Annual employer contribution to a health savings account.

• Generous paid time off.

• 10 company-paid holidays.

• Market-leading retirement plan with a company match on employee 401(k) contributions.

• Potential discretionary retirement contribution based on company performance, with no vesting period.

• Up to 12 weeks of paid parental leave after 12 months of continuous service.

• Award-winning wellness programs that incentivize participation.

• Employee Assistance Fund.

• Commute and parking benefits.

• Bonus opportunities.

• Work-from-home options.

• Employee resource groups.

• Community outreach programs supported by Cambia.

• Requirement for a wired internet connection for remote employees.

• Personal mobile device needed for Multi-Factor Authentication.