Performance Integrity Analyst I

2 weeks ago


Portland, United States Cambia Health Solutions, Inc Full time

Performance Integrity Analyst I - Claims

Remote within WA, OR, ID and UT



  • Onsite is available to those who reside near one of our office locations within our 4 state region.



  • Facets knowledge is strongly encouraged.



Primary Job Purpose:



The Performance Integrity Analyst will examine and validate Plan and employee performance according to established policies, procedures and mandated audit guidelines. Monitor accuracy and timeliness of claims, membership and customer service to meet performance and service level goals. Provide reports, feedback and recommendations for quality improvement to management.



Responsibilities:

  • Audit claims, enrollment, or customer service activities for accuracy and timeliness according to audit policies, procedures and mandated guidelines.

  • Encourage team and individual contributions toward the company's quality initiatives in improvement efforts.

  • Participate in team efforts to develop or update department standards.

  • Provide feedback on department's performance in reaching service and performance level goals.

  • Remain continuously current on changes and/or additions to all other applicable departments' policies, procedures and guidelines.

  • Thoroughly investigate problems.

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

  • Compile performance statistics and identify potential trends.

  • Generate reports.

  • Participate in testing implemented system changes.



Minimum Requirements:

  • Four years experience in Claims, Membership or Customer Service, depending on current business need, or equivalent combination of education and job-related experience.

  • Ability to understand and apply mathematical concepts.

  • Demonstrated proficient PC skills and familiarity with corporate software, such as Word, Excel and Outlook.

  • Knowledge of claims coding, BlueCard, membership and customer service processes, applicable systems including pricing and provider contract language.

  • Audit experience desirable.

  • Ability to organize and prioritize work.

  • Must be detail-oriented and self-motivated.

  • Must be able to communicate effectively both orally and in writing.

  • A written test may be administered. #LI-remote



Work Environment:

  • Work overtime and on weekends due to fluctuating workload.

  • Duties performed in a fast-paced office environment.

  • Sitting and keying for extended periods of time.



#LI-remote


  • Netsuite Analyst

    1 week ago


    Portland, United States Portland Leather Full time

    Portland Leather Goods is seeking a NetSuite Analyst with expertise in supply, manufacturing and ecommerce business functions and integrations. The NetSuite Analyst role will provide internal support for Portland Leather Goods NetSuite ERP users across ecommerce order integration, purchasing, warehouse operations and inventory management. This role will be...

  • Compensation Analyst

    3 weeks ago


    Portland, United States LHH Full time

    LHH is on the lookout for a detail-oriented Compensation Analyst to join our growing client. This role is open due to growth and will be the first-ever dedicated Compensation Analyst in the company. The Compensation Analyst is responsible for developing and maintaining compensation programs to ensure fair and competitive pay practices. The ideal candidate...

  • Compensation Analyst

    16 minutes ago


    Portland, United States LHH Full time

    LHH is on the lookout for a detail-oriented Compensation Analyst to join our growing client. This role is open due to growth and will be the first-ever dedicated Compensation Analyst in the company. The Compensation Analyst is responsible for developing and maintaining compensation programs to ensure fair and competitive pay practices. The ideal candidate...


  • Portland, United States Portland General Electric Company Full time

    Senior Technical Business Support Analyst / Principal Technical Business Support Analyst - Workday This position is responsible for fully leveraging Workday by deploying relevant new features and enhancing configurations to ensure we are utilizing existing functionality to it's fullest. This role will focus on the Core HR, Help, Talent, Learning,...


  • Portland, United States Resource Informatics Group Full time

    I am recruiting for a Business Systems Analyst ( 6 Months: Contract ) opportunity with our client locsated in Portland, OR - 100% remotely. Please let me know if you have any consultants that meets the below requirements? Please note, due to HR policy the client will not accept candidates without a LinkedIn profile. Please be sure to include the consultants...

  • Behavior Analyst

    2 weeks ago


    Portland, United States Maine Health Full time

    Full Time 37 Andover Rd Behavioral Health Day Shift * Position Summary * The Behavior Analyst-Developmental Disorders works as an integral member of the multidisciplinary treatment team addressing the challenging behaviors exhibited by patients in the Developmental Disorders Service. The Behavior Analyst-Developmental Disorders is actively involved in...


  • Portland, United States Resource Informatics Group Full time

    I am recruiting for a Business Systems Analyst ( 6 Months: Contract ) opportunity with our client locsated in Portland, OR - 100% remotely. Please let me know if you have any consultants that meets the below requirements? Please note, due to HR policy the client will not accept candidates without a LinkedIn profile. Please be sure to include the...

  • Behavior Analyst

    2 weeks ago


    Portland, United States Maine Medical Center Full time

    Summary Position Summary The Behavior Analyst-Developmental Disorders works as an integral member of the multidisciplinary treatment team addressing the challenging behaviors exhibited by patients in the Developmental Disorders Service. The Behavior Analyst-Developmental Disorders is actively involved in functional assessment, development of positive...

  • Analyst, Business

    2 weeks ago


    Portland, United States Vestas Full time

    Develop and maintain reports and dashboards relating to prevailing wage activities in Service Operations - Liaise with payroll team to ensure they have the data needed to support payment of wages to technicians performing work - Support bookkeeping e Data Science, Business Analyst, Analyst, Business, Accounting, Technology

  • Sr. Manager

    2 weeks ago


    Portland, United States LaCrosse Footwear Full time

    Job DescriptionJob DescriptionThe following statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.PRIMARY RESPONSIBILITY:As Sr Manager, Performance Marketing, you will lead the digital...


  • Portland, Oregon, United States Portland General Electric Company Full time

    Job Function: In this role, you'll track metrics and analyze data to promote operational efficiency and inform business decisions.Key Job Information Operational Analyst 6699 Grade 6 and Data Analyst 7136 Grade 6Career Level: P2 Intermediate Professional Requires expanded professional-level knowledge and experience in own area; incumbents continue to acquire...

  • Research Analyst 2

    2 weeks ago


    Portland, United States State of Oregon Full time

    Job Description: This position is a full-time, permanent, classified position which is represented by a union.Oregon Health Authority (OHA) does not offer VISA sponsorship. Within three days of hire, you will be required to complete the US Department of Homeland Security’s I-9 form confirming authorization to work in the United States.  OHA is an E-Verify...

  • System Analyst

    1 week ago


    Portland, United States eTeam Full time

    Client, Workday ,data mapping,Group Insurance Meet and coordinate with internal and external stakeholders to establish project scope, system goals, and requirements Develop, analyze, prioritize, and organize requirement specifications, data mapping, diagrams, and flowcharts for developers and testers to follow Provide documentation of all processes and...

  • Case Manager I

    6 days ago


    Portland, United States Integrative Health Network Full time

    Job DescriptionJob DescriptionIntegrative Health Network is currently hiring for a contract position (starting at 1/4 FTE with the potential to increase to 3/4 FTE) seeking a dynamic Care Manager I to join our expanding team in the areas of Southwest Washington & the Portland Metro area.The Care Manager I will be responsible for providing all-inclusive...


  • Portland, United States PacifiCorp Full time

    General Purpose Under direct supervision, the systems and development analyst conducts analysis, creates system specifications, develops, tests and implements engineering, scientific and business applications, operating systems, and file/database servers. Utilizes existing or new technology in the automation of processes. Evaluates software packages and...


  • Portland, Oregon, United States PacifiCorp Full time

    General PurposeUnder direct supervision, the systems and development analyst conducts analysis, creates system specifications, develops, tests and implements engineering, scientific and business applications, operating systems, and file/database servers. Utilizes existing or new technology in the automation of processes. Evaluates software packages and...


  • Portland, Oregon, United States Portland General Electric Company Full time

    SummaryThe Advanced Energy Delivery Technology Solutions team bears critical responsibility on behalf of Portland General Electric (PGE) to advance our clean energy future through technology advancements and integrations in building a smart grid. The mission of our team is to enable data driven decisions across the company and external stakeholders by...


  • Portland, United States Portland General Electric Company Full time

    Job Function: In this role, you'll track metrics and analyze data to promote operational efficiency and inform business decisions. Key Job Information Operational Analyst 6699 Grade 6 and Data Analyst 7136 Grade 6 Career Level: P2 Intermediate Professional Requires expanded professional-level knowledge and experience in own area; incumbents...


  • Portland, Oregon, United States Portland General Electric Company Full time

    Summary PGE's combined Clean Energy Plan and Integrated Resource Plan (CEP/IRP) marks the next step in our decarbonization journey and lays out a comprehensive roadmap for how we will meet customer energy needs and greenhouse gas emissions targets while maintaining reliability, safety and affordability. It will take all of us working together to get there....

  • System Analyst

    4 weeks ago


    Portland, Oregon, United States PacifiCorp Full time

    General PurposeResponsible for maintaining systems and their associated operating systems for computer applications. Conduct analysis, create system specifications, develop, test and implement operating systems. Utilize existing or new technology in the automation of processes. Evaluate software packages and provides recommendations to...