Manager QA and Reporting

MANAGER QA & REPORTING (HEALTHCARE)

Hybrid (In office 3 days / week) within Oregon, Washington, Idaho or Utah

Build a career with purpose. Join our to create a person-focused and economically sustainable health care system.

Who We Are Looking For :

Every day, Cambia’s Operations and Compliance Team is living our mission to make health care easier and lives better. The Manager of Quality Assurance And Reporting directs, develops and leads the staff accountable for providing Health Plan Operation Quality Assurance Auditing and Reporting. Accountable for the timely and accurate external corporate reporting for the Blue Cross Blue Shield Association (BCBSA) Local Operations Scorecard (LOS) and Licensee Desk Level Audit (LDLA), as well as Performance Guarantee performance measures. Responsible for the interpretation of LOS, LDLA, and PG policies and regulations and for the implementation of the necessary statistically valid audit procedures to assess these performance measures. May also be responsible for internal high dollar prepay, staff performance auditing activities, external audit support, or compliance audits. Responsible for writing audit programs, evaluating audit results, and reporting to internal Senior Management any quality issues and areas where quality improvement is needed. Primary business contacts include BlueCross BlueShield Association, affiliate Plan LOS or LDLA peers, Member and Provider Experience, Claims, Group and Member Administration, DTS, and Provider Services Division management – all in service of making our members’ health journeys easier.

What You Bring to Cambia :

Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

Qualifications and Certifications :

Bachelor's degree in Business, Accounting, Health Care, Management or related field

Five years of experience in claims, membership, or customer service activities is desired

minimum three years experience in a leadership or supervisory position

Equivalent combination of education and experience

Skills and Attributes (Not limited to) :

Ability to communicate effectively, verbally and in writing with all levels of Cambia personnel.

Ability to lead and participate in a team environment to achieve department goals and objectives consistent with corporate vision and strategies.

Ability to interpret regulations and external reporting requirements, plan for and successfully implement changes in LOS, LDLA, performance guarantee, and staff performance audit requirements, including appropriate sampling methodology, audit oversight, and concise and accurate reporting.

Knowledge of audit techniques and statistical sampling methods and procedures including sample sizes, variances, confidence levels, random and stratified sampling, and precision levels.

Knowledge of generally accepted auditing procedures and practices, obtained through an auditing course or prior work experience.

Knowledge of quality tools and quality improvement methodologies.

Demonstrated effective and diplomatic interpersonal skills with all levels of staff and management

Demonstrated analytical ability in identifying problems, developing solutions and implementing effective courses of action.

Ability to think clearly under pressure and project a professional image at all times.

Strong proficiency with personal computer applications including Microsoft Excel, Word, and PowerPoint.

What You Will Do at Cambia (Not limited to) :

Responsible for developing and implementing quality audits throughout Health Plan Operations to ensure that quality service levels are met or exceeded.

Prepares and maintains reference manuals and audit programs / procedure guidelines for all Quality Assurance audits and reports.

Maintains knowledge of the BlueCross and Blue Shield Association LOS Program, LDLA, and Performance Guarantee Audit measures, standards and reporting procedures.

Analyze and report audit results using graphs / trending in order to highlight and prioritize quality improvement opportunities.

Identify error trends and work with business areas to reduce repeat errors.

Lead cross-functional quality improvement initiatives by collaborating with Claims, GMA, and Member and Provider Experience, and other divisions to implement corrective action plans.

Contribute to and / or manage Quality Assurance Audit & Reporting corporate initiatives.

Prepare requests for new or changes to existing audit sampling methods and procedures. Tests sampling program changes and directs implementation.

Assists with the preparation of the annual budget for the department and monitors monthly operating expenses to ensure they are within budget.

Facilitate regular quality review meetings with cross-functional teams to discuss findings, share best practices, and coordinate improvement initiatives.

Demonstrate analytical ability in identifying problems, developing solutions and implementing an effective course of action.

Help drive the resolution and completion of outstanding Corrective Action Forms (CAF) that involve repeat audit findings.

Ensure hiring, performance evaluations, training and employee development promotes improved production and efficiency along with employee satisfaction.

Give presentations to staff or management of various departments in such a way as to promote understanding and motivation to improve or maintain corporate performance levels.

Direct and evaluate the activities of subordinates to assure work is completed in an effective accurate and timely manner.

Responsible for hiring, performance evaluations, training and employee development.

Optimize audit processes by leveraging technology where possible.

Integrate audit findings into the training and documentation programs to drive continuous improvement.

The expected target hiring range for the Mgr QA and Reporting is $ 92k – $124k is depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. The bonus target for this position is 15% . The current full salary range for this position is $86k / $141k.

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 :

Learn more about our .

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.

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