Membership Eligibility Processor I, II, or III, DOE

Work from home within Oregon, Washington, Idaho or Utah

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

Who We Are Looking For :

Every day, Cambia’s dedicated team of Member Eligibility Processors are living our mission to make health care easier and lives better.

As a member of the Membership team, our Membership Eligibility Processors establish 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 making our members’ health journeys easier.

Do you have a passion for serving others and learning new things? Then this role may be the perfect fit.

What You Bring to Cambia :

Qualifications :

The Membership Eligibility Processor II would have a high school diploma or GED and one year of experience as a Membership Eligibility Processor I with demonstrated ability to meet or exceed accuracy and production standards or an equivalent combination of education and job-related work experience.

Skills and Attributes :

40 wpm keying.

10-key by touch.

Must be detail-oriented and self-motivated.

Must be dependable and maintain attendance at or above departmental standards.

Must be able to exercise judgment, initiative and discretion in confidential, mature and sensitive manner.

Must be able to establish effective working relationships with staff and customers.

Ability to understand mathematical calculations and concepts.

Ability to organize and prioritize work.

PC experience required, experience with Word, Excel, and Outlook or similar software.

Ability to communicate effectively.

Medical Terminology for WSHIP health questionnaire processors required.

What You Will Do at Cambia :

Review, enter, and maintain changes on individual, small, large, trust or specialized group enrollment applications. Review and apply eligibility rules by calculating appropriate waiting period credit, eligibility data, effective date and enter benefits, name, social security number, address, family members and primary care physician information with network coding, which is consistent with contract.

Perform all eligibility tasks accurately and timely to meet MTM requirements, ensuring we’re complying with MTM standards, as well as Consortium standards as they relate to group membership activities.

Identify and prioritize work in order to meet deadlines including state requirements for timeliness.

Incorporate and apply changes made to Membership Accounting, Underwriting and State and Federal policies and procedures to ensure current requirements are met.

Responsible for meeting established departmental performance expectations.

Handle responses to inquiries to meet BlueCross and BlueShield Association (BCBSA) standards and corporate goals.

Provide customer service to internal customers and may place and track outgoing calls to external customers including groups, agents and subscribers to obtain information necessary for enrollment, while maintaining member confidentiality in all aspects of eligibility and billing processes.

Assist less experienced staff with questions and / or difficult issues or accounts as needed.

Maintain manuals to ensure policies and procedures are current.

Attend and participate in training and staff meetings.

The starting hourly wage for the Membership Eligibility Processor I role is $17.20 - $24.60 / hour, depending on candidate's geographic location and experience.

The starting hourly wage for the Membership Eligibility Processor II role is $17.20 - $26.60 / hour, depending on candidate's geographic location and experience.

The starting hourly wage for the Membership Eligibility Processor III role is $17.20 - $28.60 / hour, depending on candidate's geographic location and experience.

The annual incentive payment target for this position is 5%.

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 (eligible day one of employment if within first 12 months following birth or adoption).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.

Learn more about our .

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.

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and 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 .

Information about how Cambia Health Solutions collects, uses, and discloses information is available in our .

Last updated : 2024-05-31