Director Claims Operations
Oregon, Washington, Idaho or Utah
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 is living our mission to make health care easier and lives better. As a member of the Customer Experience and Operations team, our Director of Claims Operations plans, develops, and directs activities relating to claims and internal performance data to meet corporate strategic goals all in service of members' health journeys easier.
As a people leader, you are willing to learn and grow, understanding that leadership is a craft that is continuously honed as you support your team and the lives that depend upon us.
Are you passionate about the member experience? Do you strive to maximize operational efficiency? This role may be the perfect fit.
What You Bring to Cambia :
Qualifications :
- Bachelor's degree in mathematics, accounting, statistics, computer science, or related field with 8 years of related experience, 5 years management experience and experience operating strategically. Equivalent combination of education and experience may be substituted.
Skills and Attributes :
Knowledge of practices, principles, procedures, regulations and techniques as they relate to claims and related functional areas. Facets experience required.Must have fiscal management, budget preparation, expenditure control and accurate record keeping and management experience.Must have knowledge and experience with data analysis techniques and with programming languages used in retrieving data (such as SAS, Easytrieve Plus, Access, and SQL languages).Current operations knowledge of the health insurance field.Collaborative, team-based perspective.Ability to travel to all Plans and work on quality issues with geographically diverse customers and staff.Project management and effective communication skills; quality management and quality improvement principles and techniques.Leadership techniques and approaches to ensure effectiveness in leading a multi-layer organization.Technical auditing practices and statistical sampling methods.What You Will Do at Cambia :
Direct leadership for Cambia Claims performance metric management, telecommunications and technology management, customer data management, audit and reporting.Responsible for the analytical process of claims data; accountable for developing data integrity and data reconciliation with other departments.Leads projects and coordinates data requests as needed. Performs complex / critical projects and provides cost saving recommendations to senior leadership. Projects include research, planning and developing solutions and future obstacles.Provides complex analysis and recommendations regarding adequate claims services to ensure participation and cost containment goals are sustained.Develops and directs claims-related activities to ensure that Cambia effectively leads and implements initiatives required to successfully serve customers consistent with strategic direction.Maintains a leadership team approach to resolve problems or issues of overall importance. Matters that cross functional lines directly involve the position's input as well as that of other company officers, requires frequent, direct contact and close communications with peers and executives across Cambia.Direct the preparation of plan, group and other performance reports to measure claims timeliness and quality, and ensure their validity.Direct each Regence Plan's compliance with all large group performance guarantees.Direct and coordinate responses on behalf of Regence to the Blue Cross Blue Shield Association and the FEP Director's Office on quality related issuesCollaborate with other Blue Cross Blue Shield Plans on quality best practices.Assist external auditors in the completion of their audit goals including SAS 70, annual and interim reviews, and compliance audits.Trend claims quality data and develops aggregate and individual plan reports as indicatedPrepare and / or present presentations on Cambia quality / audit results for Member Services management, Cambia Executive staff, and Plan leadership.Forecasts claims volumes, in coordination with Cambia Business Intelligence, so that adequate staffing can be acquired and trained to meet the expectations of customers, providers and internal partners.A major emphasis of the position is to continually strive toward increased customer satisfaction while maintaining or increasing operational efficiency. This is accomplished through motivating all plans toward standardization resulting in increased productivity, increased accuracy and focus on member satisfaction and relative activities.Acts as a member of the Management Staff and attends all appropriate meetings to keep members informed of claims related activities as they relate to company objectives and goals.The expected hiring range for a Director of Claims Operations is $147,500-198,950 depending on skills, experience, education, and training; relevant licensure / certifications; and performance history. The bonus target for this position is 25%. The current full salary range for this role is $138,000-225,000.
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.
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 CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.
