Membership Eligibility Processor

Work from home 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 Membership Eligibility Processor lives our mission to make health care easier and lives better. As part of the Sales Support and Operations team, our Membership Eligibility Processor establishes and maintains accurate subscriber and member level eligibility through processing of new applications, member additions and deletions, policy revisions, demographic changes, renewal changes and any other maintenance affecting eligibility, 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.

Qualifications

• High school diploma or GED
• Minimum of 6 months of data entry experience

Skills And Attributes

• 30 words per minute (wpm) keying speed; 10-key proficiency by touch; demonstrated ability to meet or exceed accuracy and production standards
• Detail-oriented and self‑motivated with proven ability to maintain focus and accuracy while working independently; dependable with attendance at or above departmental standards
• Ability to exercise judgment, initiative, and discretion in confidential, mature, and sensitive manner when handling protected or sensitive information
• Strong interpersonal skills with ability to establish effective working relationships with staff and customers across various departments and levels
• Understanding of mathematical calculations and concepts; ability to organize and prioritize work effectively to meet production targets and deadlines
• PC experience required including proficiency with Word, Excel, Outlook, and similar software; comfortable with data entry software and systems
• Ability to communicate effectively in both written and verbal formats; medical terminology preferred for WSHIP health questionnaire processors; experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

What You Will Do At Cambia

• Process individual, small, large, trust, and specialized group enrollment applications; calculate appropriate waiting period credit, eligibility data, and effective dates; enter benefits, bank draft identification information, name, social security number, address, family members, and primary care physician information with network coding consistent with contract requirements
• Review, maintain, and enter changes on individual and/or group & trust accounts including change of effective date(s) for subscriber coverage or subscriber dependents, addition or deletion of insured or dependents from coverage; generate group or individual billings; order member cards; identify and prioritize work to meet deadlines including state requirements for timeliness
• Place calls to obtain information required to complete application processing such as calling an employer, member, or agent to verify date of hire, a subscriber to verify benefit selection, or the previous carrier to determine effective dates of coverage with their plan; provide customer service to internal customers and may place and track outgoing calls to external customers including groups, agents, and subscribers
• Perform all eligibility tasks accurately and timely to meet MTM requirements; incorporate and apply changes made to Membership Accounting, Underwriting, and State and Federal policies and procedures to ensure current requirements are met; comply with MTM standards as well as Consortium standards as they relate to group membership activities
• Handle responses to inquiries to meet BlueCross and BlueShield Association (BCBSA) standards and corporate goals; ensure member confidentiality in all aspects of eligibility and billing processes; maintain high regard for member and Medicare beneficiary privacy and comply with Cambia's Corporate Privacy and information security policies
• Meet established departmental performance expectations; contribute to quality and continuous improvement within job scope; support the corporation's quality initiatives by encouraging team and individual contributions toward quality improvement efforts; perform all actions/responsibilities as described in company-controlled documentation for this position
• Conduct business in compliance with the Corporate Code of Business Conduct and immediately report violations to management, human resources, internal audit, legal, or the compliance officer; aid in investigating alleged wrongdoing; review and apply eligibility rules for trust employees; willing to work overtime and on weekends as necessary; perform various clerical tasks; maintain manuals to ensure policies and procedures are current; attend and participate in training and staff meetings

Remote location available.

The expected hiring range for a Membership Eligibility Processor is $18.25 - $24.00 an hour depending on skills, experience, education, and training; relevant licensure / certifications; and performance history. The bonus target for this position is 5%. The full hourly range for this role is $18.25 - $27.20.

Benefits

• 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

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 an internet service with a minimum upload speed of 5 Mb and a minimum download speed of 10 Mb.

We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email View email address on click.appcast.io. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.