Risk Management BSA I, II, III

Risk Management - Business System Analyst I, II or IIIWork a Hybrid work schedule within Oregon, Washington, Idaho or UtahBuild 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 Business System Analysts (BSA) is living our mission to make health care easier and lives better. As a member of the Risk Management team, our BSAs are responsible for complying with CMS mandates to submit Enrollment, Medical Claim and Pharmacy Claims data for Reinsurance Reimbursement, Member Risk Assessment and Risk Corridor calculations - all in service of making our members' health journeys easier.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:The Risk Management BSA I: Bachelor's degree in Business, Data Analysis or other related field plus 2 years' experience with data analysis, process modeling or equivalent combination of education and experience.The Risk Management BSA II: Bachelor's degree in Business, Data Analysis or other related field plus 2 - 4 years' experience with data analysis, process modeling or equivalent combination of education and experience.The Risk Management BSA III: Bachelor's degree in Business, Data Analysis or other related field plus 5 - 7 years' experience with data analysis, process modeling or equivalent combination of education and experience.Skills and Attributes: Experience aggregating, reviewing and extracting data from various sources to create larger, more complex data sets. Good research and problem solving skills including the ability to determine action steps and remediation actions to resolve issues. Ability to accurately complete activities within established deadlines. Ability to work under pressure and partner with others. Good written and verbal communication skills including the ability to work with internal and external partners. Proficiency with Microsoft Office software programs and general experience database query tools. Ability to update process documentation to ensure activities and outputs align with CMS guidelines. General knowledge of medical terminology and procedure coding. Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired.Additional Requirements for BSA II: Ability to identify problems, develop solutions and implement actions with minimal supervision. Ability to develop and modify data queries for use in the CMS data submission process. Works with internal partners to test and validate the effectiveness of new or modified queries.Additional Functions and Outcomes for BSA III: Tracks and monitors CMS data submission guidelines. Reviews and verifies updates made to process documentation align with data submission guidelines. Acts as a resources to others on the Risk Management team. Updates business partner groups (enrollment, medical claims, pharmacy claims, etc.) on annual changes to CMS submission requirement.What You Will Do at Cambia: Extracts required information from the source systems into a staging area and performs validation checks based on CMS Edge Server Business Rules. Submits data to the Edge Server via an established translation process. Reviews data validation reports that are received back from CMS and any errors are investigated and corrected prior to data being resubmitted. Communicates with intTo view the full job description,click here

Created: 2025-12-04