Jobs at Cambia Health Solutions

Audits claims, enrollment, and customer service activities for accuracy, timeliness, and compliance with policies and mandated guidelines. Investigates issues, identifies process inconsistencies, monitors performance trends, compiles statistics, generates reports, recommends quality improvements, updates standards, and participates in system-change testing. The role supports Federal Employee Program operations and requires knowledge of healthcare claims, membership, customer service, coding, pricing, and provider contract processes.

Develop, automate, and execute unit, component, integration, and system tests across the software lifecycle. Review requirements, designs, code, and tests; report defects, verify fixes, assess regression impacts, and monitor quality metrics. Collaborate with development and scrum teams to improve testability, coverage, reliability, and maintainability. Participate in defect triage, create quality plans, recommend process improvements, and mentor team members on automation and test stability.

Lead commercial healthcare benefit development from initial submission through implementation and monitoring. Facilitate cross-functional Product Platform Teams, align benefit changes with product roadmaps, ensure compliance with state and federal regulations, analyze competitive and premium impacts, maintain benefit design documentation, and support Individual, Small Group, and Large Group product lines. Develop work plans, resource strategies, and decision-making processes with significant autonomy.

Serves as a finance business partner by developing budgets, forecasts, financial models, variance analyses, and business reports. Performs cost-benefit, ROI, and capital resource analyses; supports new opportunities, cost savings, process improvements, governance, and financial oversight. Provides consultation, training, presentations, and cross-functional guidance while identifying business issues and improving workflows.

Provides administrative and technical support for internal sales and renewal processes without independently soliciting sales or making quote decisions. Responsibilities include responding to inquiries, explaining benefits and eligibility rules, documenting customer interactions, reviewing and requesting information, entering data, managing correspondence and work queues, researching complex issues, resolving problems, and maintaining customer records.

Provide and maintain secure physical environments by administering access control, video surveillance, intrusion detection, and visitor systems; support SOC monitoring and incident response; coordinate vendors and law enforcement; provide executive protection and on-site security for events; maintain records, audits, and security projects. Must work on-site and assist with emergency and high-risk situations.

Senior contributor responsible for enterprise physical security operations, risk and threat assessments, incident response, executive protection, security technology oversight, vendor management, and policy/training development to ensure safety of personnel, facilities, and assets.

Lead enterprise identity architecture, designing modern authentication (adaptive MFA, passwordless) and privileged access solutions. Define reference architectures, guide security strategy and governance, partner with stakeholders, estimate and manage projects, present thought leadership, and drive continuous process and security improvements across the organization.

Lead design, implementation, and analysis of complex cost allocation methodologies for health-plan products. Manage cost accounting team; deliver regulatory reports, pricing support, forecasts, and process improvements. Ensure compliance with GAAP and applicable federal/BCBSA regulations, support audits, drive system conversions, and consult with business partners to inform pricing and operating decisions.

Provide remote provider support for EDI/EFT enrollments and Availity portal issues. Validate and process EFT enrollments, document incidents in Remedy, resolve Availity escalations, perform EFT testing, maintain internal documentation and shared inboxes, and meet service level agreements while supporting internal and external customers.

Lead end-to-end go-to-market and sustainment activities for health plan products across brands and markets. Partner with Product, Sales, and Marketing to develop launch plans, sales distribution strategies, collateral, trainings, and messaging to drive membership acquisition and retention. Manage product resources, measure ROI, and mentor cross-functional teams.

Support, configure, and maintain provider reimbursement systems: gather and define requirements, design functional solutions, perform unit/UAT/regression testing, write SQL reports and queries, troubleshoot sustainment issues, liaise between business and technology, and lead process improvements and junior analysts.

Develop and execute data-driven social media strategies across corporate channels; create and oversee content and copywriting; manage community engagement and social listening; track and report KPIs; advise and train leaders and employees on best practices; coordinate cross-functional campaigns, vendors, and live event coverage; monitor trends and platform updates to identify new opportunities.

Lead a clinical regulatory operations team to ensure Health Services Operations comply with CMS, state, NCQA, HIPAA, and contractual requirements. Design and run compliance monitoring, audits, remediation, and NCQA readiness; align and simplify processes across teams using improvement science; leverage analytics, automation, and dashboards; manage budgets, projects, and a distributed team; and partner with Regulatory, Legal, Quality, and clinical leaders to operationalize evolving regulatory requirements.

Design, implement, and maintain CI/CD, build/release, deployment, and configuration processes for cloud and host-based infrastructure. Collaborate with teams to architect solutions, build test plans, automate infrastructure as code, troubleshoot production issues, provide on-call support, and protect sensitive member health data.

Lead architecture and technical strategy for resilient database and storage infrastructure across cloud, on-prem, and hybrid environments. Design high-availability, encrypted storage and transactional database solutions, define DR/RTO/RPO, embed observability/telemetry, enforce security/compliance controls, perform capacity planning, maintain reference architectures and roadmaps, and oversee delivery and governance for large infrastructure projects.

Perform business, data and application analysis across development teams: gather and document requirements, write SQL/scripting, create story cards and technical documentation, support QA and level‑1 on‑call operations, coordinate small to large work efforts, and partner with developers, architects, vendors and business stakeholders.

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.