The Financial Analyst (internal job title is Settlement Analyst) will serve as a trusted Finance business partner regarding aspects of the provider settlement process for a variety of value based payment arrangements; coordinates with multiple departments and validates data used in the settlement and payment processes; produces contractually required monthly reporting and semi-annual settlements in a timely, accurate and easy to understand format for external provider audiences; provides financial guidance and support; supports cost savings and process improvement efforts; provides financial governance and oversight.
At Cambia, our values are fundamental to achieving our Cause of transforming the health care industry. They guide our actions and bring diverse perspectives together to improve the health care journey better for those we serve. All eight values are equally important and linked to the others: Empathy, Hope, Courage, Trust, Commitment, Innovation, Collaboration and Accountability. These values are not just words on paper - we live them every day.
Responsibilities & Requirements
- Plans, organizes, schedules, coordinates and monitors basic work streams.
- Provides training or consulting expertise to other departments, analysts and external stakeholders.
- Calculates and analyzes contracts and apply appropriate terms so providers get appropriate payment for any risk sharing arrangements they have with Regence.
- Supports Division’s network and reimbursement related projects through data analysis, research activities and/or project management.
- Uses modeling tools to measure provider contract effectiveness.
- Identify problems or needed changes, recommends resolution, and participates in quality improvement efforts.
- Perform acceptance testing of new reports, programs and models.
- Document business requirements and methods used to generate work output.
- Actively identify and eliminate inefficient or ineffective use of resources and provide recommendations on process improvements.
- Develops financial models and analysis using advanced analytical techniques and complex financial systems
- Risk sharing administration accountabilities include (when applicable):
- Primarily responsible for the timeliness, accuracy and completeness of provider settlements.
- Develop and maintain settlement workbook setup and definitions. Meet with provider group representatives to define and verify setup.
- Review, reconcile and distribute monthly claims reporting.
- Communicate regularly regarding settlement reporting status, problems and results with internal departments involved with risk arrangements. This includes provider network contractors, actuaries, finance and management.
- Serve as a participant or consultant on projects and committees related to risk sharing products.
- Calculate and process manual settlement payments and provide information to accounting to create accrual entries.
- Calculate and document interim and final settlements and coordinate settlement information with interested parties.
- Work with DTS to ensure the settlement data is working accurately and necessary enhancements are defined and implemented as needed.
- Work with PPI team on defining standard definitions and reports where possible.
- Designs, develops and implements audit system for settlements as well as desk procedures and policies.
- The Financial Analyst (internally Settlement Analyst) would have a Bachelor’s degree in business, accounting, economics, mathematics, computer science, health informatics or statistics plus 2-4 years of experience in health insurance or related field or equivalent combination of education and experience.
- General knowledge of business principles, theories and concepts.
- Effective verbal and written skills.
- Ability to effectively work with a broad range of stakeholders, including the ability to influence where applicable.
- Ability to develop, document and adhere to department policies and procedures.
- Ability to conceptualize solutions to complex problems; readily anticipates problems and identifies solutions.
- Articulates complex and/or complicated issues with a high level of skill, including listening and influence.
- Demonstrated high proficiency in the use of spreadsheet software and relational databases.
- Knowledge of health plan operations, data sources, and data structures preferred.
- Demonstrated skill in analytic programming tools and methods preferred. (SAS, SQL, OLAP, Business Objects, Crystal).
At Cambia, we advocate for transforming the health care system. You aren’t satisfied with the status quo and neither are we. We're looking for individuals who are as passionate as we are about transforming the way people experience health care. We offer a competitive salary and a generous benefits package. We are an equal opportunity 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 drug screen and background check is required.
Cambia’s portfolio of companies spans health care information technology and software development; retail health care; health insurance plans that carry the Blue Cross and Blue Shield brands; pharmacy benefit management; life, disability, dental, vision and other lines of protection; alternative solutions to health care access; and free-standing health and wellness solutions.
We have over a century of experience in developing and providing health solutions to serve our members. We had our beginnings in the logging communities of the Pacific Northwest as innovators in helping workers afford health care. That pioneering spirit has kept us at the forefront as we build new avenues to improve access to and quality of health care for the future.