Cambia Health Solutions
Cambia Health Solutions
Cambia Health Solutions is a Portland, Oregon–based nonprofit healthcare organization focused on making care more consumer-centered. As the parent organization of the Regence family of health plans, it operates health insurance and care-related businesses while investing in health innovation, including digital tools and services designed to improve how people access and experience healthcare.

Customer Service Ambassador – Partners in Care (Remote, United States)

Resolve complex member, provider, and claims-related issues as a Customer Service Ambassador with Cambia Health Solutions. Coach service teams and use trend analysis to strengthen member support.

Description

  • Act as the Partners in Care department’s subject matter expert
  • Coach and support Customer Service representatives
  • Resolve complex and escalated calls, claims, and inquiries from members, providers, employer groups, and healthcare professionals
  • Investigate claims, benefit administration errors, appeals, and correspondence issues in line with company policies and regulations
  • Explain benefits, eligibility, claims procedures, pre-authorizations, and grievance and appeal processes
  • Provide mentoring through individual guidance, help-line assistance, training, and onboarding
  • Partner with Medical, Legal, Provider Relations, Claims, and Pharmacy Services teams
  • Review data and trends to uncover recurring issues
  • Deliver ongoing education and recommendations to Customer Service leadership
  • Confirm that resolutions comply with corporate policies and regulatory requirements
  • Advise on company policies, products, processes, and Coordination of Benefits

Requirements

  • High school diploma or GED
  • At least three years of progressively responsible member service experience
  • Equivalent education and relevant technical work experience may be considered
  • Ability to report on and analyze trends, develop action plans, and assess outcomes
  • Ability to evaluate member needs accurately, build rapport, identify errors, and determine corrective actions
  • Reliable, member- and provider-focused approach with consistent adherence to departmental performance standards
  • Experience with AI tools and technologies is strongly preferred
  • A home-office setup with wired internet is required; satellite and cellular connections are not accepted, with minimum speeds of 5 Mbps upload and 10 Mbps download
  • Personal mobile device for multi-factor authentication setup
  • Successful completion of a background check

Benefits

  • 5% target bonus
  • Medical, dental, and vision insurance for employees and eligible family members, including mental health coverage
  • Annual employer contribution to a health savings account
  • Paid time off that varies by role and tenure
  • 10 company-paid holidays
  • Retirement plan with company matching on employee 401(k) contributions
  • Potential discretionary retirement contribution tied to company performance, with no vesting period
  • Up to 12 weeks of paid parental leave, subject to eligibility
  • Wellness programs that recognize participation
  • Employee Assistance Fund
  • Commuter and parking benefits
  • Flexible work-from-home options
  • Employee resource groups
  • Opportunities to participate in Cambia-supported community outreach
  • Required wired internet connection and minimum speeds for remote work
  • Personal mobile device access for multi-factor authentication

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