Jobs at Cambia Health Solutions

Leads payment integrity policy and implementation across reimbursement, coding disputes, payment edits, and affordability initiatives. Oversees policy governance, strategic planning, budgets, workflows, change management, metrics, regulatory compliance, data infrastructure, and vendor-supported operations. Partners with healthcare, clinical, legal, compliance, finance, and informatics stakeholders while supervising 3–6 direct and 40–60 total FTEs.

Own the strategy, roadmap, backlog, operational readiness, and adoption of MedInsight and actuarial analytics data products. Translate healthcare payer, actuarial, data quality, and analytics needs into product requirements and delivery priorities. Partner with engineering, analytics, actuarial, governance, architecture, operations, and vendors to deliver reliable data products, semantic capabilities, AI-enabled workflows, self-service analytics, and measurable business impact.

Twelve-week actuarial internship supporting financial and risk analysis, reporting, and strategic goals. The intern will perform technical, analytical, and support functions while working with large datasets and statistical tools. Candidates must be pursuing a relevant degree, progressing toward an actuarial exam, maintaining at least a 3.0 GPA, and demonstrating strong analytical, communication, and computer skills.

Senior HR Business Partner advising executives and senior leaders on organization design, workforce planning, talent and succession, culture, and enterprise transformation. The role leads HR initiatives for complex organizational changes and integrations, coaches leaders, assesses organizational health, and translates workforce data into actions that improve performance, engagement, retention, and leadership capability.

Lead AI product strategy, roadmaps, requirements, prioritization, and lifecycle management across multiple products. Translate healthcare business needs into AI solutions, guide cross-functional teams, conduct market research, define metrics, optimize customer experiences, and manage risks. Collaborate with engineering, UX, marketing, and healthcare stakeholders to launch products, communicate AI concepts, support responsible AI governance, and mentor product teams.

Analyzes healthcare programs and initiatives using statistical methods, data extraction, cleansing, aggregation, visualization, dashboards, and reporting. Develops queries, evaluates outcomes, identifies root causes, and translates quantitative and qualitative findings into recommendations. Collaborates with cross-functional stakeholders, supports business cases, applies regulatory knowledge, and presents standard and ad hoc analyses to guide decisions.

Develop and maintain secure, scalable applications and databases using Java, Python, microservices, APIs, cloud technologies, and modern DevOps tools. Lead cross-functional engineering efforts, design and test complex systems, resolve technical issues, conduct code and design reviews, prepare documentation, mentor junior developers, and provide technical direction. The role requires healthcare technology expertise, AWS experience, on-call availability, and work within approved development lifecycles.

Leads enterprise technology architecture for healthcare transformation initiatives. Partners with executives, business leaders, product teams, and engineers to design scalable solutions, define technology roadmaps, evaluate emerging technologies, and resolve complex integration challenges. Provides technical leadership across multiple product teams, governs architecture quality, documents solutions, mentors developers, supports implementation strategy, and aligns technology direction with business needs, healthcare industry trends, security, interoperability, and digital experience goals.

Supports and enhances provider reimbursement systems through functional design, configuration, SQL reporting, data updates, testing, troubleshooting, quality assurance, and production support. Acts as a liaison between business and technology teams, communicates system changes, responds to user inquiries, and assists with training. Senior analysts also mentor business analysts, lead projects, support process improvements, and recommend technology enhancements using tools such as Talend, Tableau, and APIs.

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.

Leads provider network strategy and contracting across Oregon and Washington, including value-based contracting, provider negotiations, network access, reimbursement, unit-cost management, quality, and affordability. Develops market and enterprise strategies, oversees operational execution, evaluates network expansion, establishes performance metrics, and partners with health plan leaders and external delivery systems. Directs resource allocation and develops high-performing teams while driving innovation, provider satisfaction, and sustainable healthcare outcomes.

Performs retrospective and prospective medical record reviews to verify accurate risk-adjustment diagnosis coding and HCC capture. Audits internal and vendor coding, identifies documentation and coding trends, supports regulatory compliance and quality improvement, and develops intervention strategies with coding leadership. Level II auditors mentor junior staff, support risk mitigation projects, interpret regulatory changes, and serve as subject matter experts for risk-adjustment coding.

Designs, configures, tests, and supports business systems for healthcare operations. Develops SQL reports and data scripts, analyzes sustainment issues, resolves defects, and recommends process and technology improvements. Serves as a liaison between business and technical teams, communicates system changes, manages assignments, supports project and production work, mentors business analysts, and backs up the Lead Business Systems Analyst.

Manages clinical pharmacy services and a team of clinical pharmacists. Oversees pharmacy program development, implementation, quality assurance, medication safety, affordability, utilization, regulatory compliance, reporting, and service-level obligations across pharmacy, medical, and specialty benefits. Leads cross-functional teams, mentors staff, manages hiring and performance, oversees budgets and resources, and collaborates with leadership, clients, vendors, and healthcare partners to improve medication outcomes and control costs.

The Associate Actuary performs actuarial analysis, develops methodologies and assumptions, creates reports, writes and tests code, reviews work products, and supports certification and regulatory responses. The role interprets business requirements, designs system solutions, improves processes, presents findings to customers, manages project documentation, ensures compliance with actuarial standards, and collaborates with actuarial and healthcare informatics teams.

Supports, maintains, enhances, configures, and delivers business systems. Translates business needs into functional requirements and system designs, develops reports and data scripts, performs unit, acceptance, end-to-end, regression, and post-implementation testing, and resolves system issues. Serves as a liaison between business and technical teams, communicates system changes, assists with end-user training, and prioritizes multiple assignments.

The Software Quality Engineer participates in agile scrum and defect triage teams; reviews requirements, designs, code, and tests; develops and executes manual and automated unit, component, system, integration, and regression tests; reports defects and verifies fixes; monitors quality metrics and test coverage; improves test stability and processes; and collaborates with development teams to ensure software testability, reliability, scalability, and maintainability.

Analyzes business, data, and application requirements for Facets health insurance systems. Creates specifications, use cases, SQL queries, technical documentation, and validation deliverables; supports testing, quality assurance, integrations, monitoring, and issue routing. Level III responsibilities include advanced SQL, automated validation, API and data-model work, complex estimates, cross-functional leadership, vendor evaluation, and coaching junior analysts.

Supports federal and state income, indirect, and premium tax compliance; tax provisions; financial disclosures; reconciliations; remittances; tax research; legislative monitoring; audits; and tax planning initiatives. The role prepares filings, documents findings, supports process improvements, and collaborates with Finance, Accounting, Legal, external consultants, and other stakeholders. This is a hybrid position requiring three days per week in an office.

Administer and support Microsoft 365 collaboration services, including Exchange Online, Teams, SharePoint Online, OneDrive, and tenant migrations. Automate administration, reporting, migrations, patching, and operational tasks with PowerShell. Monitor service health, troubleshoot tickets, document processes, support upgrades, and communicate status to customers and stakeholders while maintaining platform stability and availability.