Jobs at Cambia Health Solutions

Analyze sales and operational data to produce dashboards and KPIs, identify process improvements, manage small projects, document business processes, and partner with cross-functional stakeholders to support operational and strategic decision-making.

Manage and retain assigned small-group health insurance accounts by building broker and client relationships, cross-selling products, developing strategic account plans, advising on benefit design and underwriting, using data-driven cost models, collaborating across teams, and mentoring other account executives to drive growth and customer loyalty.

Manage and retain large ASO and fully insured group accounts through strategic relationship management with brokers, agents, and clients. Identify cross-sell opportunities, develop key account strategic plans, use data and cost modeling to inform plan design, collaborate cross-functionally, negotiate plan designs and funding, and represent the organization to drive growth and customer loyalty.

Lead design and implementation of secure, scalable cloud foundations and shared services. Build IaC, CI/CD, observability and automation, drive reliability and cost optimization, mentor engineers, and establish enterprise reference architectures and best practices.

Perform data-driven analyses, build financial models and business cases, structure hypothesis-driven solutions, and present recommendations to executives. Facilitate workshops, manage multiple workstreams, and leverage data and AI tools to support strategic initiatives in healthcare.

Provide project support for Payment Integrity: assist with project initiation, planning, monitoring and control; maintain schedules, budgets, documentation, risks, issues and deliverables; prepare status reports and presentations; coordinate meetings; ensure compliance with EPMO standards and support quality assurance activities.

Perform program and outcomes analyses for healthcare informatics using statistical and analytical tools. Extract, clean, aggregate, and visualize large datasets; develop dashboards, reports, and recommendations. Apply advanced analytics and policy knowledge to evaluate programs, guide decisions, and present findings to stakeholders. Collaborate cross-functionally and support testing, implementation, and training.

Lead architecture and technical strategy for production AI systems: prototype solutions, build reference implementations, define observability/evaluation/governance standards, bridge Applied AI and enterprise architecture, design integrations and cloud-native patterns, mentor engineers, and influence portfolio and partner decisions in a regulated healthcare environment.

Lead high-impact strategy and innovation engagements for a health care payer, advising senior leaders, developing execution plans, performing quantitative and qualitative analyses, forecasting market trends, and managing multiple projects and executive workshops to drive long-term enterprise growth.

Technical lead for data engineering who designs, builds, and owns scalable Snowflake ELT pipelines and data models. Mentors engineers, drives standards, optimizes performance and costs, and partners with product, analytics, QA, and governance to deliver observable, high-quality data solutions. Contributes to platform strategy, DataOps/CI/CD adoption, and ensures data quality, testing, and documentation.

Serve as a trusted strategic finance business partner: build budgets and forecasts, develop complex financial models, perform variance and ROI/cost-benefit analyses, support proposals and capital decisions, drive cost-savings and process improvements, provide financial governance, present findings to stakeholders, and mentor/guide other analysts.

Lead and manage strategic provider contracting relationships, negotiate complex contracts and reimbursement models, analyze financial and utilization data to develop contracting strategies, oversee regional network development and risk arrangements, mentor staff, and drive initiatives to improve performance, cost-effectiveness, and quality of care.

Lead and grow data engineering teams to build and sustain enterprise data platforms. Partner with product, governance, and business teams to design scalable data models, optimize platform performance, drive modern data practices (semantic layers, metadata, CI/CD), manage budgets, and guide technology migrations while delivering high-value analytics and operational reporting in a complex healthcare environment.

Perform post-service claim reviews using nursing expertise to ensure appropriate clinical determinations, accurate coding, and correct reimbursement. Review medical records, apply medical and reimbursement policies, consult physician advisors, resolve provider/member claim issues, and maintain clinical competency and required licensure/certifications.

Design and document end-to-end digital architectures for customer acquisition, advise stakeholders, lead technology evaluations and integrations (cloud, APIs, SaaS), mentor teams, drive architecture governance, and estimate resources and timelines. Architect II adds enterprise-wide strategy, reference architectures, and cross-organization technical leadership.

Lead strategic sourcing and contract management for indirect spend categories. Develop category strategies, run RFx sourcing events, negotiate contracts and SOWs, perform spend analysis and financial modeling, drive cost savings, manage supplier relationships, and lead cross-functional sourcing projects and continuous improvement.

Lead a team of clinical pharmacists to design, implement, and optimize pharmacy quality, affordability, and medication management programs (including Medicare Stars/HEDIS). Manage vendor relationships, cross-functional initiatives, compliance with Medicare/CMS and state/federal regulations, analyze medication claims, and oversee staffing, budgets, and performance to improve outcomes and affordability.

Design, implement, and maintain an effective healthcare compliance program. Perform risk assessments, monitoring, auditing, investigations, root cause analysis, policy creation, training, audit coordination, reporting, and corrective actions. Manage compliance projects, collaborate across teams, and ensure regulatory adherence for Medicare/ACA requirements. Support continuous improvement and occasionally travel locally.

Own architecture for Corporate Solutions (Finance, Legal, Compliance, Imaging, Middleware). Assess complex legacy systems, develop modernization roadmaps, design integrations and data pipelines, evaluate AI/third-party platforms, guide build vs. buy decisions, mentor engineers, perform hands-on proofs of concept, and document solutions in the EA environment to enable scalable, maintainable systems.

Prepare monthly journal entries, balance sheet reconciliations, and financial statement sections; maintain cost allocation tables; analyze budget variances, cost trends and allocations; support audits, system implementations, forecasting, and accounting research; mentor and train junior accountants; and participate in cross-functional projects, process improvements, and ad-hoc financial analysis.