Cambia Health Solutions

Systems Engineer

• Read and create simple structured specifications such as use cases, data mappings (PDMs), story cards.
• Read and understand design and business models including basic technical understanding.
• Writes SQL queries, reads simple data models.
• Understands and participates in the creation of deliverables by acting as a liaison between the development team and business users.
• Contributes to deliverables through analysis, SQL/scripting, and quality validation to ensure system requirements are met and data integrity is maintained.
• Provides incident triage support including application monitoring, issue identification and stakeholder communications to ensure timely resolution of system incidents.
• Manages tasks on smaller work efforts to support the software development methodology, ensuring alignment with project requirements and timelines.
• Actively acquire in depth knowledge of Health Care and Insurance terminology and concepts.
• Provides estimates for small tasks increasing accuracy of the estimate as work effort progresses.
• Reviews and validates documentation with internal team and business stakeholders to ensure clarity and completeness before development begins.

Systems Analyst II – IV

Executive Assistant

• Serve as the right hand to healthcare leaders shaping the future of patient care.
• Master the art of calendar choreography—balancing competing priorities with finesse.
• Ensure seamless travel experiences and flawless expense management.
• Prepare compelling content and coordinate high-impact team meetings.
• Own the full lifecycle of department events—from budget to execution.
• Coordinate logistics that bring people together and ideas to life.
• Manage technical setups and data that power strategic decisions.
• Interface confidently with C-suite executives, external partners, and board members.
• Streamline processes including security access, compliance tracking, and system administration.
• Craft department communications that inform and inspire.
• Coordinate resources, equipment, and services that keep the team running smoothly.
• Provide critical backup support to ensure continuity across the administrative team.

Executive Assistant I/II

Solutions Engineer

• Build working prototypes to validate technical approaches, demonstrate feasibility, and build stakeholder alignment
• Write production-quality code when needed to fill gaps, solve complex problems, or establish patterns for teams to follow
• Conduct hands-on technical evaluations of emerging AI technologies, frameworks, and platforms
• Build proof-of-concepts that translate strategy into tangible demonstrations
• Establish architectural patterns for AI systems through working examples and reference implementations
• Define standards for AI-specific concerns: evaluation frameworks, observability, monitoring, safety guardrails, model governance, and responsible AI practices
• Create and maintain reference architectures for common patterns (RAG systems, agentic applications, ML pipelines)
• Lead technical design reviews and document architectural decisions
• Serve as primary liaison between Applied AI and enterprise architecture/platform engineering teams

Senior AI/ML Solutions Architect

Business Intelligence Analyst

• Provides analytical support to any or all divisions of the organization by mining data, conducting analysis, and interpreting results related to business needs, while developing methodologies and approaches to new tasks and projects through design and development of analytical models and reports.
• Develop knowledge of health plan operations, health plan data sources and structures, and cost containment strategies, and reviews data as it relates to health plan operations to assist with the development of cost containment strategies.
• Proactively identifies issues, concerns, problems, or needed changes to management, recommends resolutions, and participates in quality improvement efforts while actively identifying and eliminating inefficient or ineffective use of resources and providing recommendations on process improvements.
• Identifies needed reporting, assembles or directs the assembly of reports, distributes such information, and performs acceptance testing of new reports, programs, and models.
• Documents business requirements and methods used to generate work output, and serves as a resource on analytic programming tools and methods.
• Drives analytic innovation and best practices within Cambia and may supervise the gathering and analysis of information.
• May assist in training of other team members.

Broker Reporting Analyst

Product Manager

• This role will focus on a subset of the total enterprise data domain and own product roadmap for Cambia's Snowflake-native data, analytics, and semantics— driving the evolution of how the enterprise defines, governs, and delivers trusted data products to business consumers and AI systems alike.
• Own and drive the delivery roadmap for data, analytics, and semantic products across assigned business domains, balancing near-term value delivery with long-term platform coherence.
• Lead stakeholder engagement across business partners, data engineering, and analytics consumers to identify opportunities where governed data and AI capabilities can drive measurable outcomes.
• Partner with Semantic Analysts, Data Engineers, and AI product teams to translate business intent into well-defined semantic models, metric definitions, and context layers on the Snowflake platform (dbt Semantic Layer, Snowflake Cortex, Sigma).
• Deeply understand enterprise strategy and business domain priorities; surface and champion opportunities where applied AI, semantic intelligence, and analytics can accelerate decision-making at scale.
• Drive product decisions across the semantic layer — including entity definitions, metric governance, ontology design, and the organizational context layer that powers AI agent reasoning.
• Balance business and technical objectives in feature prioritization — serving both human consumers (analysts, operators) and machine consumers (Cortex agents, AI workflows).
• Coordinate across the enterprise data and analytics landscape to sequence initiatives strategically, avoid definitional fragmentation, and maximize platform-wide impact.
• Lead the translation of business requirements into precise, implementable product requirements, including prototypes, semantic contracts, data quality SLAs, and AI-ready context specifications.
• Manage complex product and technical decisions in partnership with TPMs and engineering, operating within an agile delivery model.
• Build alignment with internal and third-party partners (Snowflake, Sigma, dbt Labs) on platform capabilities, roadmap integration, and joint development opportunities.
• Define and communicate product success metrics — including semantic layer adoption, metric trust scores, AI agent accuracy, and analytics platform utilization — and drive continuous improvement based on those signals.

Senior Technical Data and Analytics Product Manager

Operations

• Demonstrate strong knowledge of clinical protocols, operational procedures, and systems used to support day-to-day prior authorization (PA), appeals, and related workflows, while serving as the key liaison within the PA team to ensure seamless implementation of process changes, system enhancements, and regulatory initiatives.
• Support operational and regulatory requirements and initiatives by coordinating cross-departmental implementation to ensure accurate and compliant PA, appeal, and related processes across the organization.
• Lead and/or contribute to preparations for compliance audits, accreditation documentation, government audits, and state audits to maintain organizational standards and regulatory compliance.
• Coordinate with stakeholders to ensure new processes, procedures, regulations, and initiatives are clearly communicated, documented, and implemented in a timely and accurate manner across all affected teams.
• Interact, coordinate, and communicate with all levels of management including but not limited to providers, stakeholders, and vendors to ensure effective and compliant use of systems and processes, provide project updates, and ensure coordination of activities.
• Support internal audits of PA and appeal case review by reviewing authorization accuracy, validating adherence to clinical policies, and supporting continuous quality improvement initiatives.
• Other duties as assigned to support the overall goals and objectives of the Pharmacy Operations Team.

Pharmacy Operations Coordinator

Vice President

• Establish Payment Integrity strategy as key member of Cost Stewardship leadership team, partnering with Performance and Affordability teams to optimize healthcare value
• Present strategic initiatives and operational results to Board and C-suite stakeholders
• Direct pre-pay and post-pay audit programs, recovery operations, and provider-facing activities across all claim types
• Manage large-scale service provider relationships and optimize audit performance delivery
• Deploy AI/ML solutions and advanced analytics for payment accuracy and competitive advantage
• Design enterprise measurement frameworks with KPIs tracking audit effectiveness and recovery performance
• Build high-performing teams through strategic talent acquisition, succession planning, and performance management
• Lead large-scale organizational change initiatives across matrixed healthcare payer environment

Vice President – Payment Integrity

AI Research Scientist

• AI Scientists work with various stakeholders to design, develop, and implement data-driven solutions.
• This position applies expertise in advanced analytical tools such as generative AI, machine learning, deep learning, optimization, and statistical modeling to solve business problems in the healthcare payer domain.
• AI Scientists work may focus on a particular area of the business such as clinical care delivery, customer experience, or payment integrity, or they may work across several areas spanning the organization.
• AI Scientists work closely with AI team members in the Product and Engineering tracks to collaboratively develop and deliver models and data-driven products.
• AI Scientists also collaborate and communicate with business partners to design and develop data-driven solutions to business problems and interpret and communicate results to technical and non-technical audiences – all in service of making our members’ health journeys easier.

AI Scientist II – Healthcare

Implementation Specialist

• Accountable for delivering multiple projects to successful completion, ensuring quality, timeliness, and adherence to budgetary constraints.
• Plan, direct, coordinate, and report project management activities in accordance with Enterprise Program Management Office policies and standards.
• Manage overall project plans and present status reports to organizational leadership, project teams, and client/customer groups.
• Ensure project outcomes through effective planning, scope management, resource allocation, risk mitigation, cost management, and stakeholder communication.
• Assemble and lead project teams by assigning responsibilities, identifying resources, and providing guidance and direction to team members.
• Define, collect, and analyze metrics to ensure projects remain on target while proactively recommending cost-effective courses of action.
• Contribute to development of company-adopted project management methods and ensure timely resolution of problems within project scope.

Product Implementation Manager – II

Manager

• Serve as the enterprise owner and single point of accountability for the TrendSmart/TrendWise EBR platform.
• Define and drive the strategic roadmap for platform enhancements and performance optimization.
• Lead cross-functional initiatives aligning platform capabilities with enterprise objectives.
• Develop business cases and provide data-driven recommendations to leadership.
• Establish and monitor platform performance metrics and utilization trends.
• Own and govern user access provisioning and lifecycle management.
• Design and deliver role-based training and maintain platform documentation.
• Oversee expert-level issue resolution and act as final authority on data interpretation.
• Lead enhancement lifecycle including requirements, UAT, and production readiness.
• Manage vendor relationship ensuring SLA compliance and service quality.
• Own data governance, refresh processes, audits, and compliance escalation.

Senior Employer Based Reporting Platform Manager

• Manage product roadmap, prioritization, and sprint planning while defining feature sets, business requirements, and measures of success from multiple stakeholder sources.
• Direct product management activities to meet business, market segmentation, and financial goals while tracking product profitability and enrollment metrics.
• Produce product requirements and specifications (functional requirements, user stories, wireframes) for multiple projects simultaneously, interfacing with marketing, UX, engineering, and category management teams.
• Understand internal markets and primary user needs through research and collaboration with internal teams, brokers, and sales.
• Guide product lifecycle from planning through tactical execution to cross-company go-to-market planning and launch.

Data Product Manager – Provider, Quality

• 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.

Supervisor – Appeal Operations

Analyst

• Responsible for ensuring Cambia is meeting network adequacy requirements for Medicare Advantage and Qualified Health Plan networks, as well as local regulatory network adequacy requirements across a broad range of specialties and geographies.
• Conducts regulatory filings and submission of required reporting for provider network adequacy and access to maintain compliance with state, federal, and CMS requirements, and resolves all questions, issues, and objections related to such filings, such as Medicare HSD tables.
• Responsible for analysis of access gaps and opportunities by provider specialty, and consolidating data for the purpose of recommending network changes.
• Responsible for assessing provider networks using efficiency and effectiveness data for the purpose of network architecture.
• Provides analytical support and supports internal customers with network assessments and corrective actions to address network deficiencies and opportunities.
• Evaluate existing network adequacy policies and procedures, including verification of compliance standards, lead implementation of recommended updates, and development of new policies and procedures.
• Performs regular network adequacy evaluations to support provider contract negotiations, provider terminations, and provider network optimization.
• Produce summaries that interpret network adequacy and access report outcomes and findings and suggest strategies and recommendations for improvement to contracting teams.

Provider Network Data Adequacy Analyst

Full-stack Engineer

• Responsible for programming, debugging, building, deploying, testing, and documentation of applications in development and production environments.
• Responsible for database design and system testing and documentation.
• Develops and/or directs the creation of efficient and maintainable program code.
• Contributes to multiple Communities of Practice and may hold more than one Team Champion role.
• Prepares and/or directs the creation of program, system, operational and System documentation.
• Seeks to improve policies and procedures.

Software Development Engineer II – III

Data Engineer

• Together with Engineering and Data Modeling leaders, define and evolve enterprise standards for dimensional modeling, semantic layers, and analytics-ready data platforms.
• Serve as a design authority for complex operational, analytic, data pipeline, and semantic architectures, reviewing and approving high‑impact solutions
• Guide engineers on technical solutions and techniques to optimize compute and storage cost.
• Oversee design and optimization of scalable ELT/ETL pipelines and data products, with a focus on reliability, performance, and cost efficiency.
• Drive platform observability, proactive data quality monitoring, and automated validation frameworks.
• Lead performance tuning efforts for Snowflake tables, views, materialized views, and semantic access patterns.
• Guide the design and implementation of enterprise semantic models on Snowflake, including facts, dimensions, metrics, and governed business logic.
• Collaborate with the Data Product and Data Modeling teams to establish patterns for metric definitions, conformed dimensions, and reusable semantic assets.
• Partner with Enterprise and Domain Architects to ensure semantic consistency, interoperability, and scalability
• Ensure semantic layers are optimized for BI tools, self‑service analytics, and agentic/AI consumption.
• Enable trusted data foundations for agent‑based analytics and AI assistants, ensuring semantic models are consumable by LLMs and analytic agents.
• Collaborate with platform and AI teams to define contracts, metadata, and observability required for intelligent agents.
• Influence responsible AI usage by embedding governance, lineage, and explainability into semantic designs.
• Champion data governance, security, and compliance across operational, analytical, semantic, and agentic platforms.
• Ensure solutions meet healthcare and regulated‑industry expectations for auditability and reliability.