Member Services Lead - Claims

Member Service Lead - Claims

Remote Within WA, OR, ID, UT

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

• All qualified candidates will be invited to participate in a timed assessment. If you are selected to move forward to an interview, HR will reach out to schedule an interview with the hiring team.

Who We Are looking For:

Every day, Cambia’s dedicated team in Member Services are living our mission to make health care easier and lives better. As a Member Service Lead for Claims you will assist your supervisor in accomplishing and supporting department and corporate strategic objectives by organizing, monitoring, training and scheduling staff activities to meet or exceed performance standards and service level goals. 

Leads keep lines of communication open between management and staff, and establish excellent rapport with all levels of staff and external customers.  The Lead may also function as a technical resource for the department or, alternatively, may focus on training and coaching employees, depending on needs of the particular department.  This position leads employees but has no reporting subordinates.

What You Bring to Cambia:

Qualifications:

• High School diploma or GED

• Minimum five years progressive work experience in customer service, claims processing, membership billing or enrollment, as applicable to position

• Equivalent combination of education and experience

• Healthcare experience preferred.

Skills and Attributes:

• You'll possess excellent verbal and written communication skills, with the ability to interpret and communicate information with tact, diplomacy, patience, and professionalism, while also demonstrating analytical ability in identifying problems, developing solutions, and implementing a course of action.

• You'll be proficient in PC skills, including Word, Excel, and Outlook, as well as other corporate software programs or comparable software, and be able to prioritize and delegate work to ensure efficient operations.

• You'll serve as a resource to correct technical and/or system problems, and be able to recognize and research invalid claims or inquiries, resolving and communicating resolutions to concerned parties in a timely and professional manner.

• You'll possess strong interpersonal skills, with the ability to listen and communicate effectively with a diverse range of stakeholders, including the provider community, members, employer groups, agents, member representatives, and coworkers, while maintaining confidentiality and promoting positive, professional interactions.

• You'll have knowledge of State and Federal Regulations, particularly for Government Programs related jobs, and be able to apply this knowledge to ensure compliance and effective operations, while also demonstrating the ability to work independently and as part of a team.

What You Will Do at Cambia:

• You'll handle difficult or escalated calls, claims, or inquiries from various stakeholders, thoroughly researching and resolving issues, while providing coaching and assistance to team members and promoting internal customer service.

• You'll ensure superior customer service to both internal and external clients, following through on commitments, and assist in monitoring and distributing staff workload to meet service requirements, while also providing feedback and coaching to employees on routine performance issues.

• You'll assist in improving department performance by participating in meetings, identifying training needs, and making recommendations for ongoing training, while also helping to establish department goals, gathering service information, and evaluating trends and outcomes.

• You'll maintain reference manuals and procedure guidelines, troubleshoot system malfunctions, and participate in system enhancements, development, coordination, testing, and implementation, while also complying with MTM and Consortium standards and corporate goals.

• You'll represent the department on company-wide teams and work groups, complete special projects and reports as assigned, and be willing to work overtime and on weekends as needed, while also assisting in interviewing applicants and providing input on employee performance, and backing up the supervisor as needed.

#LI-remote

The starting pay range for the Member Service Lead is $26.00 - $32.00 an hour depending on experience and geographical location. The full pay range for this role is $23.80- $41.30

The bonus target for this position is 5%. 

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