Cambia Health Solutions

The Account Executive is primarily responsible for strategic account management, retaining group business within their assigned territory, and establishing strategic relationships with agents. They must also cross-sell other lines of business directly or through brokers/agents while working effectively within a team environment.

This role facilitates timely, high-quality responses to RFPs, RFIs, and surveys for clinical areas by collaborating with sales and operational teams to gather and represent accurate product and service information. The coordinator also develops and creates accurate sales material content consistent with the clinical value proposition and manages the inventory of sales content for relevance.

Broker Reporting Analyst providing analytical support for Cambia's health care operations

Pharmacy Operations Coordinator optimizing healthcare operations at Cambia

This role involves coordinating operational and cross-functional teams to deliver initiatives that optimize prior authorization (PA) operations through enhanced efficiency, regulatory compliance, training, and quality improvements. Demonstrate strong knowledge of clinical protoco...

This role involves performing retrospective and prospective chart reviews to ensure accurate risk adjustment reporting. Verifies and ensures the accuracy, completeness, specificity, and appropriateness of provider-reported diagnosis codes based on medical record documentation. Re...

This role involves managing all activities associated with requests for Provider Billing Disputes and Appeals. Analyze, prepare, and evaluate prior determinations Coordinate clinical review if needed Make decisions and provide notifications Follow guidelines outlined by contracts...

This role involves providing technical support for pharmacy benefit, reimbursement, and other drug use issues which do not require clinical judgment. The Pharmacy Services Technician assists the Clinical Pharmacy Consultants and Pharmacy Services staff with formulary-related oper...

Supervisor overseeing Appeals Operations team for health insurance claims processing

This role involves supervising the Appeal Operations team and acting as a resource for Certified Professional Coders and non-clinical support staff. Oversees and coordinates team activities to achieve business objectives. Ensures timely processing of member and provider claims in...