PERMANENT

FULL_TIME

ADAPTED_NOW

YEAR

Overseas and coordinates team activities to achieve business objectives and ensure the timely processing of member and provider claims and are in alignment with contract provisions, proper coding, policy or regulatory compliance across multiple lines of business, all in service of creating a person-focused health care experience. Develops and maintains desk reference guides on work procedures, ensures new hires complete necessary training, and assesses training needs while playing an active role in staff development.

Supervisor of Appeal Operations 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 Supervisor Appeals Operations, are living our mission to make healthcare easier and lives better. As a member of the Appeal Operations team, our Supervisor Appeals Operations supervises the team and acts as a resource for Certified Professional Coders, and/or non-clinical support staff. Overseas and coordinates team activities to achieve business objectives and ensure the timely processing of member and provider claims and are in alignment with contract provisions, proper coding, policy or regulatory compliance across multiple lines of business, 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: * Bachelor's degree in healthcare or related field * 3 years of leadership experience in the health insurance industry * 5 years of claims review, customer service, or membership experience * Equivalent combination of education and experience considered * Coding experience strongly preferred * Supervises 8-12 FTEs Skills and Attributes: * Demonstrated competency in setting priorities for a team and overseeing work outputs and timelines * Ability to communicate effectively, both verbally and in writing * Ability to effectively develop and lead a team, including employees in multiple locations or working remotely * Demonstrated experience in recognizing problems and effectively resolving complex issues * Familiarity with health insurance industry trends and technology * Knowledge of medical terminology and payment coding guidelines, as applicable * Experience with AI tools and technologies to enhance productivity and decision-making in professional settings (highly desired) What You Will Do at Cambia: * Assigns and prioritizes work, sets goals, and coordinates daily activities of the team. Provides regular updates and communication to staff through 1:1 and team meetings. * Monitors individual and team results to ensure work is completed in a timely manner, in accordance with department standards and procedures, and in compliance with medical policy and medical necessity guidelines. * Assists in development of productivity and quality standards. Conducts or participates in compliance audits, reports audit findings, and identifies and implements process improvements as needed. * Acts as a resource for staff and others. Appropriately escalates issues, partners with other departments to resolve issues and remove barriers and collaborates with physician advisors on complex cases. * Participates in the hiring process and provides ongoing coaching, employee development, and performance reviews. Develops and maintains desk reference guides on work procedures, ensures new hires complete necessary training, and assesses training needs while playing an active role in staff development. * Completes special projects as assigned and provides back-up support to staff as needed. May develop and present educational updates internally or to other departments. * Seeks ideas and opportunities for continuous improvement, determines which opportunities should be pursued, and implements improvements as appropriate. #LI - Remote The expected hiring range for a Supervisor of Appeal Operationsis $76,500 - $103,500 salary depending on skills, experience, education, and training; relevant licensure / certifications; and performance history. The bonus To view the full job description, <a href="https://www.aplitrak.com/?adid=YmJnZW5lcmljLjQzMTI3Ljg3NjlAY2FtYmlhaGVhbHRoY29tcC5hcGxpdHJhay5jb20" rel="nofollow">click here</a>

Cambia Health Solutions is a family of companies headquartered in Portland, Oregon, working to create a person-focused and economically sustainable health care system. 

Through our health plans, innovative technology and strategic investments, we are delivering consumer-centric solutions that:

•       help people achieve better health and well-being 
•       make health care more available, affordable and accessible 
•       are easily understood by everyone

We put people at the heart of everything we do. Our company reaches more than 70 million Americans nationwide, including more than two million people in the Pacific Northwest who are enrolled in our regional health plans.  

Cambia Health Solutions

Supervisor of Appeal Operations

Artificial Intelligence (AI)

Certified Professional Coder (CPC)

Clinical Support

Coaching

Communication Skills

Continuous Improvement

Customer Support/Service

Establish Priorities

Health Economics

Health Insurance

Healthcare

Industry/Trade Analysis

Leadership

Maintain Compliance

Medical Coding

Medical Terminology

Medical Treatment

Needs Assessment

Operations Management

Performance Reviews

Problem Solving Skills

Process Improvement

Project Tracking

Quality Metrics

Regulatory Compliance

Set Goals

Staff Development

Systems Maintenance

Team Lead/Manager

Team Player

Time Management

Training/Teaching

Work From Home

monster

In addition to the registered pharmacist license, successful completion of a pharmacy residency, or advanced degree in health-related field preferred with four years of experience in a clinical ambulatory care/hospital setting, or equivalent experience and at least three years' experience with pharmacy sales, business development or pharmacy benefit management or an equivalent combination of education and experience. Assists the Pharmacy Sales and Account Management Team in planning, developing, and implementing clinical strategies for Pharmacy clients with respect to formulary management, drug utilization management, medication therapy management programs, quality initiatives and drug information and education - all in service of making our members' health journeys easier.

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 team of Pharmacists are living our mission to make health care easier and lives better. As a member of the Pharmacy Services team, our Clinical Pharmacist Client Manager  is responsible for providing clinical guidance, reporting, program recommendations and benefit strategies in support of the Pharmacy Sales and Account Management goals. Works in collaboration with the Pharmacy Sales and Account Management team.  Identifies, leads, and measures the impact of pharmacy program opportunities that impact client cost, utilization, and quality metrics. Synthesizes client utilization data, benefit designs, employee value proposition goals, and pharmacy clinical programs and provides client specific recommendations to improve pharmacy program performance. Provides professional and clinical expertise for Pharmacy clients in making clinical decisions based on best practices in applying evidence-based medicine evaluations to determine the best quality medication choices that represent the best value in efficacy and safety. Assists the Pharmacy Sales and Account Management Team in planning, developing, and implementing clinical strategies for Pharmacy clients with respect to formulary management, drug utilization management, medication therapy management programs, quality initiatives and drug information and education - all in service of making our members' health journeys easier. Are you looking for a position where evidence-based medicine meets innovative healthcare solutions? Are you the pharmacist who sees the bigger picture beyond the prescription counter? Then this role may be the perfect fit.  What You Bring to Cambia:  Qualifications:  BS or Pharm.D. (preferred) degree in Pharmacy with the appropriate states' Pharmacy license.   In addition to the registered pharmacist license, successful completion of a pharmacy residency, or advanced degree in health-related field preferred with four years of experience in a clinical ambulatory care/hospital setting, or equivalent experience and at least three years' experience with pharmacy sales, business development or pharmacy benefit management or an equivalent combination of education and experience. Must be an active and unrestricted licensed pharmacist in state of practice. Skills and Attributes:  Comprehensive expertise in pharmacy benefit management, benefit design, pharmacy products/services, competitive market offerings, and health plan structures with thorough understanding of healthcare economics and pharmaceutical industry dynamics Deep clinical pharmacy knowledge with ability to apply evidence-based medicine principles to formulary design, medication coverage policies, and medication management solutions in clinical care settings Skilled at interpreting complex clinical information, claims data, and regulatory requirements to develop practical business solutions and meet quarterly clinical reporting goals Strong business analytical and project management capabilities with understanding of pharmacy/provider service reimbursement structures Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired Proven ability to deliver exceptional customer service, build lasting client relationships, and collaborate effectively in team environments Excellent written and verbal communication abilities, including effective presentation skills for diverse audiences ranging from clients to senior management Strong negotiation capabilities with demonstrated success in managing professional relationships, client expectations, and developing creative solutions for existing and prospective clients What You Will Do at Cambia:   Develop and maintain clinical client-business relationships while identifying and assisting in the development of new products and services specific to ASO groups Create clinical content for presentations and educational materials to inform potential or existing clients, members, and providers about Pharmacy Services products, medication coverage choices, comparative effectiveness, and coverage determinations Provide clinical pharmacy consultation supporting business plan development, sales, revenue, expense controls, and promoting Pharmacy Services presence while ensuring client satisfaction and repeat business through proactive issue resolution Collect, analyze, interpret, and forecast healthcare cost information based on prescribing patterns and medication utilization reports, presenting findings clearly and concisely to pharmacy clients Deliver creative thinking and leadership to accomplish quality improvement and cost-effective prescription drug program goals while providing clinical context for coverage recommendations on prior authorizations, appeals, retrospective claim reviews, and audits Provide consultative expertise to internal and external decision-making bodies including Pharmacy and Therapeutics Committees and Medication Policy Groups regarding formulary and medication coverage policy considerations Support effective clinical consultation to diverse stakeholders including members, medical directors, account representatives, case managers, customer services, appeals/grievance panels, and external providers based on medication coverage policies, member benefit contracts, and provider contracts Work Environment Occasional travel required, locally or out of state. #LI-Remote The expected hiring range for a Clinical Pharmacist Client Manager is $136,000 - $184,000 depending on skills, experience, education, and training; relevant licensure / certifications; and performance history. The bonus target for this position is 15%. The current full salary range for this role is $128,000 - $208,000. 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. 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 CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.\n \nApply here: https://www.aplitrak.com/?adid=YmJnZW5lcmljLjY2ODM5Ljg3NjlAY2FtYmlhaGVhbHRoY29tcC5hcGxpdHJhay5jb20

Clinical Pharmacist Client Manager

Ambulatory Care

Analysis Skills

Best Practices

Biotech and Pharmaceutical

Business Analysis

Business Development

Business Plan

Business Solutions

Case Management

Clinical Information

Clinical Medicine

Clinical Practices/Protocols

Compensation and Benefits

Content Development

Cost Control

Cost Forecasting

Customer Relations

Customer Relationship Management (CRM)

Customer Satisfaction

Develop and Maintain Customers

Employee Benefits

Formulary

Health Plan

Hospital

Internet/Online Service

Leading Edge Technology

Loans

Medications

Medicine

Negotiation Skills

Performance Management

Pharmacy

Prescription Drugs

Presentation/Verbal Skills

Product Design

Product Development

Project/Program Management

Provider Contracting

Quality Assurance

Quality Management

Regulatory Requirements

Reimbursement

Sales

Sales Management

Sales Prospecting

Utilization Management

Willing to Travel

Writing Skills

As a member of the Stop Loss team, this position adjudicates all stop loss claims by developing policies and procedures to ensure consistent claim practices and adherence to policy and contract terms, appropriate laws and regulations - all in service of creating a person-focused health care experience. The expected hiring range for a Stop Loss Claims Analyst is $68,900.00 - $93,150.00 depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location.

---Job Description---- Stop Loss Claims Analysts 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 team of Stop Loss Claims Analysts is living our mission to make health care easier and lives better. As a member of the Stop Loss team, this position adjudicates all stop loss claims by developing policies and procedures to ensure consistent claim practices and adherence to policy and contract terms, appropriate laws and regulations - 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 Analyst would have a/an High School Diploma or GED and 5 years of professional claims processing experience or equivalent combination of education and experience. Skills and Attributes: * Knowledge of when to utilize legal and clinical resources to comprehend legal and medical terminology in order to make final determinations on whether to approve or further investigate a claim. * Possess strong knowledge of Policy and Contract terms, lasering, aggregating deductibles and eligibility to ensure correct processing of all eligible claim reimbursements. * Advanced knowledge of claim reserving and settlement. * Excellent communication skills for both external and internal customers * Demonstrate understanding of medical terminology and ICD-10/CPT coding. * Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired. * Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired What You Will Do at Cambia: * Accurately apply contract benefits within guidelines and recognize incomplete or inappropriate claims. Recognize all policies and procedures that apply to claim and be able to quickly reference documentation for details. * Make informed decisions regarding the disposition of claim; may include payment or denial of claim, or requests for further information. * Lead the process to measure, track, and report all aggregate claims. * Audit all aggregate claims onsite and off-site when needed based on set dollar threshold. Provide client audit reporting as needed. * Manage inventory of claims while ensuring best practices and claim standards are met. * Identify new opportunities to track and process claims more efficiently. Thoroughly document claims throughout the adjudication process so they can be understood by the team and for audit purposes. * Analyze and investigate all claims, request supplementary documentation as necessary, in order to process or reprocess claims in a timely and accurate manner. Work Environment * No unusual working conditions. * Work is primarily performed in an office environment. The expected hiring range for a Stop Loss Claims Analyst is $68,900.00 - $93,150.00 depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. The bonus target for this position is 6.25%. The current full salary range for this role is $64,000.00 to $106,000.00. #LI-remote 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, To view the full job description, <a href="https://www.aplitrak.com/?adid=YmJnZW5lcmljLjY2MjYzLjg3NjlAY2FtYmlhaGVhbHRoY29tcC5hcGxpdHJhay5jb20" rel="nofollow">click here ----Company Information---- !*!*! Use Pre-Filled Information !*!*!</a>

Stop Loss Claims Analyst

Adjudication

Claims Management

Claims Processing

Current Procedural Terminology (CPT)

Documentation

ICD-10

Inventory Management

Legal

Policy Development

Procedure Development

Regulations

Stop Loss Insurance

UNKNOWN

FEED

OTHER

Interested candidates who meet the licensure requirements are encouraged to submit their resume and a brief cover letter outlining their experience and desired part-time schedule by applying on this job posting or email to gethired@seasonedrecruitment.com. Licensure: Must hold a current and active Full Clinical License to practice therapy in the State of Washington (WA) (e.g., LMHC, LICSW, LMFT, Psychologist).

Job Title: Remote Fully Licensed Therapist (Part-Time, 1099 Contractor) - Washington StateAbout UsOur client is a growing, remote-first mental health practice dedicated to providing accessible and high-quality therapy services. We value clinician well-being and offer a supportive environment where you can focus entirely on client care without the administrative burden of building your own practice.The OpportunityWe are seeking a dedicated and experienced Fully Licensed Therapist to join our team as a part-time 1099 contractor. This is a fully remote position, allowing you to serve clients across Washington State from the comfort of your own home office.Key Position Details:<ul><li>Employment Type: 1099 Independent Contractor</li><li>Schedule: Part-time (2-3 days per week). Must have availability on either Mondays or Fridays.</li><li>Client Caseload: We provide the caseload. Providers do NOT need to bring their own clients.</li><li>Start Date: We offer a streamlined process with fast credentialing and quick start dates.</li></ul>Compensation & Benefits<ul><li>Pay Split: 60/40 compensation split.</li><li>Cancellations: Reimbursement is provided for last-minute cancellations and no-shows, contingent on reimbursement from the insurance company.</li><li>Support: Access to a full administrative and billing team.</li></ul>Responsibilities<ul><li>Provide high-quality, evidence-based psychotherapy to individuals, couples, or families via a secure telehealth platform.</li><li>Maintain accurate and timely clinical documentation in compliance with all ethical and legal standards.</li><li>Manage a provided caseload and work collaboratively with the administrative team.</li></ul>How to ApplyInterested candidates who meet the licensure requirements are encouraged to submit their resume and a brief cover letter outlining their experience and desired part-time schedule by applying on this job posting or email to gethired@seasonedrecruitment.comRequirementsQualifications<ul><li>Licensure: Must hold a current and active Full Clinical License to practice therapy in the State of Washington (WA) (e.g., LMHC, LICSW, LMFT, Psychologist).</li><li>Technology: Must have a private, HIPAA-compliant space for remote sessions and a reliable internet connection.</li></ul>

Seasoned Recruitment

Remote Fully Licensed Therapist (Part-Time, 1099 Contractor) - Washington State

Workable

In this 100% work-from-home role, you will assist clients with travel-related questions, provide trip support, and ensure a smooth, stress-free experience from start to finish. This position is ideal for someone who enjoys helping people, is highly organized, and is excited about working remotely in the travel industry.

We are seeking a Remote Travel Customer Representative to support travelers before, during, and after their trips. In this 100% work-from-home role, you will assist clients with travel-related questions, provide trip support, and ensure a smooth, stress-free experience from start to finish.This position is ideal for someone who enjoys helping people, is highly organized, and is excited about working remotely in the travel industry.Key ResponsibilitiesAssist clients remotely via email, phone, and messaging platformsAnswer travel-related inquiries in a clear, professional, and friendly mannerSupport itinerary updates, cancellations, changes, and special requestsProvide guidance on destinations, travel requirements, and agency proceduresMonitor upcoming trips and proactively communicate with clients when neededResolve issues efficiently while maintaining a positive customer experienceIdeal CandidateStrong written and verbal communication skillsCustomer service experience (travel, hospitality, call center, or support roles preferred)Highly organized, dependable, and detail-orientedComfortable working independently in a remote environmentAble to learn new systems, tools, and processes quicklyPassionate about travel and helping others travel with confidenceWhat We Offer100% remote, work-from-home positionFlexible scheduling optionsFull training and ongoing supportGrowth opportunities within a travel-focused companyAccess to travel-related perks and industry discountsSupportive and collaborative remote team environment

Cross Borders with Alex

Remote Travel Customer Representative

Manatal

Join our dynamic team and enjoy the freedom to grow at your own pace, set your own income goals, and thrive in a culture that challenges you to surpass your personal best every day. With world-class mentorship and support, you’ll have the guidance and tools to unlock your full potential while exploring countless growth opportunities.

<h2>Unleash Your Potential</h2>Ignite your career with AO, a rapidly growing company where your success is determined by your drive. Join our dynamic team and enjoy the freedom to grow at your own pace, set your own income goals, and thrive in a culture that challenges you to surpass your personal best every day.With world-class mentorship and support, you’ll have the guidance and tools to unlock your full potential while exploring countless growth opportunities.<h3>What We Offer</h3><ul><li>100% Work From Home – Flexible schedule to achieve your goals on your terms</li><li>Virtual Workshops & Training – Stay ahead with cutting-edge professional development</li><li>Weekly Pay + Bonuses – Rewarding your outstanding performance</li><li>Union Contract & Representation – Ensuring your voice is heard and your rights protected</li><li>Life Insurance (including Accidental Death Benefits) – Secure your future</li><li>Medical Insurance Reimbursement – Prioritize your well-being</li><li>Industry-Leading Technology & Tools – Equip yourself for success</li><li>Leadership Conventions & Conferences – Learn, network, and grow</li><li>Incentive Trips & Team Bonding – Celebrate achievements and build lasting connections</li></ul><h3>How to Apply</h3>To be considered, submit your updated resume and compensation requirements for review.In the interest of community wellness, all interviews will be conducted via Zoom video conferencing.Join AO today and ignite your potential —let’s make insurance exciting together!Powered by JazzHR

Globe Life AIL - Lisa Russel

Remote CSR – Career Starter

partner JazzHR

Work From Home Jobs in Yakima, WA