Opl Examiner I

OPL Examiner I

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 Cambias dedicated OPL Examiner I are living our mission to make healthcare easier and lives better. As a member of Claims Operations Team our OPL Examiner I is responsible to review claims routed to Other Party Liability (OPL) department for possible third party investigation under the direction of the supervisor and manager to determine the Companys course of action on intentional and unintentional injury and occupational injury claims by initiating the investigation of potential first and third party liability. Responsible to review sort and triage returned incident reports and correspondence in light of information received and claims history and to release claims that are not third-party liability. Responsible to code claim system and tracking systems promptly and accurately with steps and findings about investigations initiated or closed as review is completed. Responsible for providing specialized technical and cost-effective support in the investigation to assure maximum third-party savings. Responsible to support workflow intake tracking and triage to ensure maximum workflow efficiency accountability and controls 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:

• High school diploma or GED equivalent required.

• Minimum 2 years of related work experience preferably in claims processing or an equivalent combination of education and work experience.

Skills and Attributes:

• Excellent interpersonal skills with demonstrated basic knowledge of medical terminology CPT and ICD-9 coding and ability to type 30 wpm or 8500 keystrokes per hour with 95% accuracy.

• Demonstrated 10-key skills basic knowledge of claims systems and associated documents and demonstrated understanding of OPL rules and regulations governed by contract exclusions is preferred.

• Ability to work with a high volume of claims and correspondence while keeping detailed and accurate records combined with strong analytical ability.

• Demonstrated ability in organizational problem-solving and time-management skills with the ability to exercise initiative and independently make decisions within the scope of assigned authority while operating with minimum supervision.

• Ability to work as part of a team demonstrate efficiency meet established deadlines triage and be flexible in evaluating competing priorities and be responsive available and timely.

• Demonstrated proficient use of a PC and Windows software including Microsoft Word and Excel.

• Facets experience or experience with claims systems used within Regence preferred and experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired.

What You Will Do at Cambia:

• Handles all claims pended as potential third-party liability investigates initial need for further information relating to potential contract exclusions and generates needed incident reports and correspondence for clarification surrounding third party information.

• Follows up on all pends received and investigates all claims determined to need further assessment.

• Sorts reviews triages and further investigates returned incident reports e-mails and correspondence related to third-party claims for possible contract exclusion or subrogation action then routes and handles appropriately.

• Reviews and determine appropriate need for adjustments by performing appropriate history sweeps of the claims system to support the Companys effort in third-party savings.

• Utilizes appropriate file management reporting and savings tracking systems and prepares weekly and monthly statistics on work record/profile.

• Codes claim system and tracking systems promptly and accurately with steps and findings about investigations initiated or closed as review is completed providing specialized technical and cost-effective support in the investigation to assure maximum third-party savings.

• Supports workflow intake tracking and triage to ensure maximum workflow efficiency accountability and controls.

#LI Remote

The expected hiring range for a OPL Examiner I 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 current full hourly range for this role is $18.25 - $27.20

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 were 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.