Stop Loss Claims Specialist

Stop Loss Claims Specialist

Work a hybrid schedule within Oregon, Washington, Idaho or Utah 

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

Who We Are Looking For: 

Every day, Cambia’s dedicated Stop Loss team is living our mission to make health care easier and lives better. As a member of the Stop Loss team, our Stop Loss Claims Specialist supports the Stop Loss Claims team through data entry of claims, explanation of payment, adjudicating complex claims data, and completing detailed reporting for team. Provides other administrative support as directed. – all in service of creating a person-focused health care experience.  

Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit. 

What You Bring to Cambia: 

Qualifications:

Stop Loss Claims Specialist would have a High School diploma or GED and 4 years office, data entry or equivalent combination of education and experience, preferably in a health care environment. Knowledge of stop loss claims processing preferred.

Skills and Attributes: 

• Demonstrated ability to exercise sound judgment, initiative and discretion in a mature, sensitive and confidential manner.

• Proven attention to detail and accuracy in data entry and other administrative tasks.

• Computer skills including experience using Microsoft Office (Word, Excel, Outlook) or comparable software and ability to learn and use complex systems.

• Ability to organize, prioritize and manage multiple tasks with little supervision.

• Demonstrated ability to establish effective working relationships with coworkers and customers and to both work well independently and on a team.

• Ability to communicate effectively both orally and in writing.

• Knowledge of medical terminology, insurance billing and claims Coding of ICD-10 and CPT.

• Demonstrated strong problem solving skills and ability to investigate and resolve complex issues.

• Demonstrated ability to consistently meet productivity and quality standards with minimal support.

• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

What You Will Do at Cambia:  

• Perform data input into claims module, claims spreadsheet and claims system for payment

• Enter all required fields to generate Explanation of Payment forms.

• Run reports, review and analyze data and identify any areas of concern.

• Review data and prepare management reports.

• Understanding Stop-Loss policy language and terms.

• Review Group Specific Plan Documents

• Other duties as assigned

Work Environment

• No unusual working conditions.
• Work primarily performed in a home office environment.

The starting hourly wage for a Stop Loss Underwriting Specialist is $19.20-$34.90/hour, depending on the geographic location and expertise of the candidate. The bonus target for this position is 6.25%.

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.