Moda HealthInpatient Claims Processor I Moda HealthInpatient Claims Processor IMilwaukie, OR$21.30–$23.96 / hourReview, analyze, price, and resolve inpatient claims through the utilization of available resources for moderate to complex inpatient claims, adjustments, and file reviews. Works internally with Healthcare Services, Membership Accounting, Customer Service, Hospital Auditors, Provider Correspondence, and Professional Relations.
Moda HealthMedical Claims Processor I Moda HealthMedical Claims Processor IMilwaukie, OR$17.34–$19.41 / hourResponsible for utilizing resources efficiently for the accurate and timely entry, review, and resolution of simple to moderately complex medical claims in accordance with policies, procedures, and guidelines as outlined by the company. For more information regarding accommodations, please direct your questions to Kristy Nehler & Danielle Baker via our humanresources@modahealth.com email.
Moda HealthDental Claims Processor I Moda HealthDental Claims Processor IMILWAUKIE, OR$17.34–$18.36 / hourFor more information regarding accommodations, please direct your questions to Kristy Nehler & Danielle Baker via our humanresources@modahealth.com email. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees.
Moda HealthMedical Claims COB Processor I Moda HealthMedical Claims COB Processor IMilwaukie, OR$18.39–$20.58 / hourAssists in customer service inquiries regarding contractual and administrative policies and applies excellent customer service when a phone call is needed to complete a COB claim. Minimum of 6 months medical claim processing or customer service dealing with all types of plans/claims and consistently exceeding performance levels.
Moda HealthSupervisor, Medical Claims Moda HealthSupervisor, Medical ClaimsMilwaukie, OR$59,922.05–$74,902.56 / yearControls workflow and quality by checking date and amount of work in processors queues, assigns work to ensure time service goals, tracks processors production and quality. Facilitates problem solving for employees and Manager by answering claims related questions dealing with contract interpretation of benefits, procedures and claims systems.
Moda HealthTrainer CS & Claims I - Internal Applicants Only Moda HealthTrainer CS & Claims I - Internal Applicants OnlyMilwaukie, OR$25.58–$28.78 / hourThis position collaborates regularly within Claims & CS Training Department, coordinating work with other Moda Departments, Leadership and Stakeholders (IE: Claims Processing, Customer Service, IT, Facilities, Etc.) Directly communicates with Members, Providers, Vendors, and other Insurance Carriers regarding Moda Policies and Member Benefits information. Core responsibilities include developing and updating all training materials, facilitating virtual training classes, documenting learner performance, and consistently demonstrating professionalism both in and out of the classroom.
Moda HealthMedical Claims Support I Moda HealthMedical Claims Support IMilwaukie, OR$21.30–$23.96 / hourPerforms COB updates (excluding Commercial), file reviews, issues adjustment related letters to members and providers, performs payment offsets and also validates and completes stop payment requests. Assists in customer service inquiries regarding contractual and administrative policies and applies excellent customer service when a phone call is needed to complete an adjustment or other support work.
Moda HealthMedical Claims Auditor I Moda HealthMedical Claims Auditor IMilwaukie, OR$18.39–$20.58 / hourInternally with Claims, Sales & Account Services, Membership Accounting, Benefit Configuration, Information Services, Customer Service and Provider Relations. 6 months – 2 years claim processing or customer service dealing with all types of plans/claims consistently exceeding performance levels.
Consonus PharmacyPharmacy Technician - Claims Review Consonus PharmacyPharmacy Technician - Claims ReviewPortland, OregonAs the Claims Review Specialist, your responsibilities will include prior authorizations, answering questions regarding prior authorizations, apply for prior authorizations and communicate with facilities and physicians, work daily rejects, communication with internal departments. Consonus Pharmacy is a closed-door long-term care pharmacy specializing in the needs of nursing facilities, assisted living residents, and their caregivers.
ResCare Premier Inc.Revenue Cycle Support Specialist ResCare Premier Inc.Revenue Cycle Support SpecialistVancouver, WA$19–$21 / hourFull timeThe Revenue Cycle Support Specialist (aka Prior Authorization Coordinator) is responsible for striving to complete either approval for pharmacy claims requiring prior authorization or by coordinating with prescribers and or facility contact to have therapy changed to a preferred alternative due to insurance not covering the treatment in question. The Prior Authorization Coordinator is responsible for striving to complete either approval for pharmacy claims requiring prior authorization or by coordinating with prescribers and or facility contact to have therapy changed to a preferred alternative due to insurance not covering the treatment in question.
Compass OncologyInsurance Specialist - Billing/ Follow Up Compass OncologyInsurance Specialist - Billing/ Follow UpVancouver, WAFull timeAs a member of The US Oncology Network, one of the nation's largest community-based cancer treatment and research networks, Compass Oncology participates in leading-edge clinical trials through US Oncology research, which has helped develop 89 FDA approved cancer therapies. If you are a dedicated, team-oriented, patient-centered individual looking for an opportunity where you are proud of what you do, work hard, have fun, want to learn and go home at the end of the day knowing you made a difference in the lives of our patients; Compass Oncology is the place for you!
Cambia Health SolutionsSpv Business Support Services Cambia Health SolutionsSpv Business Support ServicesVancouver, WAFull timeThis includes support of global configuration, incident resolution, conversion activities, enhancement design, developing general and detailed functional and business requirements, testing, project work, and support in the production environments. This includes scoping and resources planning for any projects related to configuration and support of any Facets system, any associated extension or interface that interacts with Facets, along with all legacy membership systems.
Cambia Health SolutionsBusiness Systems Analyst Support Services Lead Cambia Health SolutionsBusiness Systems Analyst Support Services LeadVancouver, WAFull timeAs a member of the Customer Experience and Operations team, our Business Systems Analyst Support Services Lead participates in the daily support, maintenance, and enhancement of existing systems, as well as the development, configuration, and delivery of new systems to directly support Cambia Core Strategies and Key Initiatives - all in service of economically sustainable health care system. * Demonstrated ability to develop project plans and schedules to ensure all tasks are identified and completed, and assigns tasks and workflow as necessary for completion, including the ability to support and answer questions from Level I team members.
Cambia Health SolutionsPharmacy Program Manager Cambia Health SolutionsPharmacy Program ManagerVancouver, WAFull timeDeep knowledge of pharmacy benefit management, benefit design, pharmacy products and services, competitive offerings, and client needs, including advanced understanding of healthcare operations, cost containment strategies, provider contracting methodologies, and benefit design alternatives. As a member of the Pharmacy Services team, our Pharmacy Program Managers are responsible for partnering with clinical stakeholders to develop, execute, evaluate and maintain clinical programs and strategies to support cost containment and clinical quality improvements related to pharmacy.
Cambia Health SolutionsPolicy & Implementation Analyst or Sr. DOE Cambia Health SolutionsPolicy & Implementation Analyst or Sr. DOEVancouver, WAFull timeServes as primary support for CPT/HCPCS procedure and ICD-9/ICD-10 diagnosis coding questions across Cambia, ensuring decision-making related to coding is consistent, clinically appropriate and thoroughly documented. * Facilitates development, understanding and documentation of business requirements related to policy implementation, clinical editing, and reimbursement policy development including issue identification, research, approval, implementation, documentation and education.
Liberty Mutual Holding Company IncClaims Specialist - Rideshare Commercial Auto - Attorney Represented Bodily Injury Claims Adjuster Liberty Mutual Holding Company IncClaims Specialist - Rideshare Commercial Auto - Attorney Represented Bodily Injury Claims AdjusterLake Oswego, ORAssesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim, refers claims to the subrogation group or Special Investigations Unit as appropriate. You will be required to go into the office twice a month if you reside within 50 miles of one of the following offices: Boston, MA; Westborough, MA; Hoffman Estates, IL; Weatogue, CT; Indianapolis, IN; Plano, TX; Suwanee, GA; or Lake Oswego, OR; Las Vegas, NV; Chandler, AZ.
Liberty Mutual Holding Company IncClaims Specialist - Rideshare Commercial Auto Claims Injury Adjuster Liberty Mutual Holding Company IncClaims Specialist - Rideshare Commercial Auto Claims Injury AdjusterLake Oswego, ORQualifications BS/BA degree or equivalent work experience Minimum of 2 years experience in claims adjustment, general insurance or formal claims training Required to obtain and maintain all applicable licenses Continuing education courses leading to industry certifications preferred (e.g., AEI, IIA, CPCU) Knowledge of claims investigation techniques, medical terminology and legal aspects of claims. • Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim, refers claims to the subrogation group or Special Investigations Unit as appropriate.
U.S. BancorpSenior Operations Processor 6 U.S. BancorpSenior Operations Processor 6Gresham, OR$24.18–$32.21 / hourThis role supports regulatory claims processing within a team focused on Regulation E. The position is responsible for researching and reviewing claims, making determinations in accordance with regulatory requirements, and completing associated operational tasks such as processing monetary adjustments, sending written customer communications, handling recoveries, and coordinating with internal departments. In addition, certain positions may also be subject to the requirements of FINRA, NMLS registration, Reg Z, Reg G, OFAC, the NFA, the FCPA, the Bank Secrecy Act, the SAFE Act, and/or federal guidelines applicable to an agreement, such as those related to ethics, safety, or operational procedures.
CVS Health CorpNewSenior Claims Benefit Specialist CVS Health CorpSenior Claims Benefit SpecialistWork At Home, OR$18.50–$42.35 / hourOur teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Review and adjust SF (self-funded), FI (fully insured), Reinsurance, and/or RX claims; adjudicates complex, sensitive, and/or specialized claims in accordance with claim processing guidelines.
Maddox Industrial TransformerClaims Specialist Maddox Industrial TransformerClaims SpecialistBattle Ground, WashingtonOur goal is to ensure an industry leading customer experience at every point of the claims process by facilitating the ease of doing business and driving customer retention through prompt post-fulfillment claim mitigation and resolution. Maddox is the nation’s leading provider of electrical transformers to the commercial and industrial market, with primary locations in South Carolina, Washington State, Texas, Idaho, and Ohio.
Alera GroupWC Claims Consultant Alera GroupWC Claims ConsultantPortland, OregonRemoteService timeline focus is on larger Valued or 360 Clients for onboarding new accounts and establishing claims services with their carrier/TPA/applicable vendors, providing claims oversight, employer training, and scheduling Claim Reviews and various presentations. WC Claims Consultants work independently with clients and their carrier/TPA consulting on large reserves, coverage issues, return to work issues, settlements, and other items that have a significant impact on retention and premiums.
CopperPoint Insurance CoSupervisor Workers Comp Claims - PNW CopperPoint Insurance CoSupervisor Workers Comp Claims - PNWPortland, ORRemote$105,000–$135,000 / yearThe majority of the supervision for this team is currently Alaska and Idaho workers' compensation claims- experience is a must for AK, and candidate must be willing and able to quickly learn ID jurisdiction and obtain licensure if no prior experience with ID claims. Develops and maintains partnerships and service level agreements with leaders within other divisions to ensure processes and workflows are effective, and customer service goals are being met.
Moda HealthMedical Claims Clerk I Moda HealthMedical Claims Clerk IMilwaukie, OR$19.43–$21.86 / hourScan and index mail using designated printers and software, and prepare documents for submission to Imaging according to established workflows. Manage assigned Content Manager image queues and work baskets and prioritize tasks based on urgency, service levels, and departmental guidelines.
TriWest Healthcare AllianceClaims Reviewer TriWest Healthcare AllianceClaims ReviewerPortland, ORRemoteFull timeProficient with claim and coding tools and resources, Clinical Decision Support Tool, Current Procedural Terminology, Health Care Financing Administration Common Procedure Coding System, and American Dental coding. Provides clinical and coding-related information to medical director, providers, peer reviewers, Claims Administration, Program Integrity, Quality Management, and/or the Claims Subcontractor as needed.
United Employers Association and its AffiliatesClaims Examiner/Member Services Representative United Employers Association and its AffiliatesClaims Examiner/Member Services RepresentativePortland, ORSmall Health and Welfare Claims Administrator seeks full-time Claims Examiner/Member Services Representative to process claims and provide outstanding customer service to external and internal clients. Successful candidate must be detail oriented, possess excellent interpersonal skills, be a master communicator, and demonstrate a strong desire to assist others and continuously learn.
HUB InternationalSenior Claims Advocate HUB InternationalSenior Claims AdvocateLake Oswego, ORWe are the perfect fit if you: + are seeking a progressive work environment at a rapidly growing organization + have a desire to help others protect their future + have an entrepreneurial spirit and are challenged by the opportunity to grow the business + are focused on learning and development to enhance your industry knowledge and expertise + are a self-starter willing to invest time and energy to learn the technical aspects of our business + believe in integrity and building success by developing relationships with others **Here's Where You Come In** We are currently seeking a Senior Claims Advocate to join our growing Commercial Insurance Claims team. Our entrepreneurial culture fosters an environment that empowers our people to make the best decisions for our customers and organization, focusing on expanding the industry knowledge of our insurance professionals to better serve our valued clients.
Hub International InsuranceSenior Claims Advocate Hub International InsuranceSenior Claims AdvocateLake Oswego, OregonOur entrepreneurial culture fosters an environment that empowers our people to make the best decisions for our customers and organization, focusing on expanding the industry knowledge of our insurance professionals to better serve our valued clients. Our growing team of professionals across North America represents a broad, deep, and one-of-a kind aggregation of entrepreneurs and leaders recognized for their excellence throughout the insurance community.
Moda HealthLead Medical Claims Auditor I Moda HealthLead Medical Claims Auditor IMilwaukie, OR$20.88–$23.49 / hourStrong analytical, problem solving, and decision-making skills with demonstrated ability to handle and resolve complaints, correct errors, and resolve departmental issues in accordance with Moda contracts and company policies. Includes monitoring of assignments and overtime, evaluating performance, training, communicating policy to staff, and answering questions from Claims Auditors and Reinsurance Specialists.
CopperPoint Insurance CoSr. Adjuster-Workers Comp Claims CopperPoint Insurance CoSr. Adjuster-Workers Comp ClaimsORRemote$65,000–$120,000 / yearThe Workers' Compensation Claims Adjuster Senior, Indemnity is responsible for analyzing time loss workers' compensation claims to determine compensability. We provide some benefits at no cost to the employee (Basic Life Insurance and AD&D at two times an employee's annual salary, Short- and Long-term Disability coverage, and Employee Assistant Plan).
Liberty Mutual Holding Company IncField Property Claims Adjuster Liberty Mutual Holding Company IncField Property Claims AdjusterWest Linn, ORThe full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. This is a role where people who love every day to be new, different and exciting, can thrive - you'll be traveling on the road to meet customers in person, providing hands-on assessment of damage and empathetic support.
Philadelphia Insurance CompaniesClaims Supervisor II - Property Philadelphia Insurance CompaniesClaims Supervisor II - PropertyWest Linn, OR$114,408–$127,868 / yearSummary: Supervises claims adjusters and technical support staff to manage the day-to-day handling and settlement of claims, the processing and tracking of documents, making payments, tracking trends and communicating with underwriting. Marketing Statement: Philadelphia Insurance Companies, a member of the Tokio Marine Group, designs, markets and underwrites commercial property/casualty and professional liability insurance products for select industries.
Philadelphia Insurance CompaniesClaims Supervisor II - Commercial Auto - BI Philadelphia Insurance CompaniesClaims Supervisor II - Commercial Auto - BIWest Linn, OR$114,408–$148,058 / yearSummary: Supervises claims adjusters and technical support staff to manage the day-to-day handling and settlement of claims, the processing and tracking of documents, making payments, tracking trends and communicating with underwriting. Marketing Statement: Philadelphia Insurance Companies, a member of the Tokio Marine Group, designs, markets and underwrites commercial property/casualty and professional liability insurance products for select industries.
GallagherSenior Workers Compensation Claims Adjuster GallagherSenior Workers Compensation Claims AdjusterPortland, OregonRemote
GallagherSenior Workers Compensation Claims Adjuster - OR/WA GallagherSenior Workers Compensation Claims Adjuster - OR/WAPortland, OregonRemote
TriWest Healthcare AllianceSupervisor, Claims Admin TriWest Healthcare AllianceSupervisor, Claims AdminPortland, ORRemoteFull timeThe Supervisor, Claims Administration interacts and collaborates frequently with beneficiaries, Veterans, providers, sub-contractors, the Government, and internal business partners to resolve issues, respond to inquiries, and improve processes. Organizational Skills: Ability to organize people or tasks, adjusts to priorities, learns systems within time constraints and with available resources; detail-oriented.
TriWest Healthcare AllianceClaims Recoup & Collect Anlyst TriWest Healthcare AllianceClaims Recoup & Collect AnlystPortland, ORRemoteFull timeUnder limited supervision, manages and performs claims department activities related to recoupments and collections, including validation of recoupment setup, conducting collections calls with providers, establishing payment arrangements, tracking and trending outstanding recoupments, establishing payment arrangements, and coordinating collections activities with other departments. Proficient with claim and coding tools such as Supercoder, Clinical Decision Support Tool, Current Procedural Terminology, Health Care Financing Administration Common Procedure Coding System, and American Dental coding.
Great American Insurance CompanySenior Claims Specialist - CA Workers'''' Compensation Great American Insurance CompanySenior Claims Specialist - CA Workers'''' CompensationOR$110,000–$120,000 / yearAlthough we typically require 10+ years of experience, we will consider exceptional candidates with 7+ years of proven success in California workers' compensation claims adjusting experience with higher exposure claims. We take an extremely aggressive and proactive approach to claims adjusting and are looking for the person who not only knows their territory's comp laws but also enjoys the role of putting that experience to good use.
Allstate Insurance CompanyNewLarge Loss Claims Admin Allstate Insurance CompanyLarge Loss Claims AdminOR$18.61–$27.79 / hourBusiness Communications, Claims Processing, Clerical Skills, Data Entry, Detail-Oriented, Documentations, Insurance Claims, Investigative Thinking, Invoice Processing, Invoices, Large Loss Claims, Large Scale Data Processing, Microsoft Excel, Microsoft Office, Office Administration, Organizing, Outbound Calls, Police Reports, Timeliness. In this role, you will handle a variety of administrative tasks, including ordering police reports, submitting claims to other carriers, completing social media and trace report requests, and processing invoices.
The Hanover Insurance Group IncWC Lost Time - Sr Consultant Casualty Claims - Southwest The Hanover Insurance Group IncWC Lost Time - Sr Consultant Casualty Claims - SouthwestPortland, ORCompensation: The target hiring range for this role may vary based on geographic location and other factors, including merit or performance, demonstrated proficiency, skills for the role, education, travel requirements, and experience. Individuals with disabilities who wish to request a reasonable accommodation to participate in the job application or interview process, or to perform essential job functions, should contact us at:HRServices@hanover.com and include the link of the job posting in which you are interested.
The Progressive CorpClaims Adjuster - Attorney Represented Injury The Progressive CorpClaims Adjuster - Attorney Represented InjuryTigard, OR$69,400–$89,800 / yearAn ideal candidate will have experience managing an inventory independently, experience assessing and evaluating liability, coverage, and damages, as well as working independently and directly with attorneys to negotiate and settle claims. For ideas about how you might be able to protect yourself from job scams, visit our scam-awareness page at https://careers.progressive.com/pages/how-we-hire-faq-job-scams/.
Assurant IncFinancial Services Claims Adjuster Assurant IncFinancial Services Claims AdjusterOR$19.08–$30.53 / hourA Fortune 500 company with a presence in 21 countries, Assurant supports the advancement of the connected world by partnering with the world's leading brands to develop innovative solutions and deliver an enhanced customer experience through mobile device solutions, extended service contracts, vehicle protection services, renters insurance, lender-placed insurance products, and other specialty products. Named a Best/Great Place to Work in 14 countries and awarded the Fortune America's Most Innovative Companies recognition, we bring together top talent around the world.
Chubb LtdESIS Claims Representative, WC Chubb LtdESIS Claims Representative, WCPortland, OR$67,000–$83,000 / yearThe company is distinguished by its extensive product and service offerings, broad distribution capabilities, exceptional financial strength, underwriting excellence, superior claims handling expertise and local operations globally. With more than 70 years of experience, and offerings in both the U.S. and globally, ESIS provides one of the industrys broadest selections of risk management solutions covering both pre- and post-loss services.
CNA Financial CorpComplex Claims Consultant - Private & NFP D&O CNA Financial CorpComplex Claims Consultant - Private & NFP D&OPortland, OR$72,000–$141,000 / yearPerforms a combination of duties in accordance with departmental guidelines: Manages an inventory of highly complex Financial Lines claims, with large exposures that require a high degree of specialized technical expertise and coordination, by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits. Resolves claims by collaborating with internal and external business partners to develop, own and execute a claim resolution strategy, that includes management of timely and adequate reserves, collaborating with coverage experts, negotiating complex settlements, partnering with counsel to manage complex litigation and authorizing payments within scope of authority.
IMA Financial GroupClaims Executive - Workers Comp IMA Financial GroupClaims Executive - Workers CompPortland, OR$87,000–$130,000 / yearIn addition to our robust benefits package, the final offer amounts will depend on a variety of factors, including the candidate's geographic location, prior relevant experience, and their knowledge, skills, and abilities. Our plans are cost-effective, convenient and provide progressive ways for staying healthy, protecting loved ones, pursuing financial security and living a full and balanced life.
The IMA Financial Group IncClaims Executive - Workers Comp The IMA Financial Group IncClaims Executive - Workers CompPortland, OR$87,000–$130,000 / yearIn addition to our robust benefits package, the final offer amounts will depend on a variety of factors, including the candidate's geographic location, prior relevant experience, and their knowledge, skills, and abilities. Our plans are cost-effective, convenient and provide progressive ways for staying healthy, protecting loved ones, pursuing financial security and living a full and balanced life.
Chubb LtdESIS Senior Claims Representative, WC Chubb LtdESIS Senior Claims Representative, WCPortland, OR$71,000–$104,000 / yearContacts, interviews, and obtains statements from insured parties, claimants, witnesses, medical professionals, legal representatives, law enforcement, and other relevant individuals to gather necessary claim information. The company is distinguished by its extensive product and service offerings, broad distribution capabilities, exceptional financial strength, underwriting excellence, superior claims handling expertise and local operations globally.
TriWest Healthcare AllianceSr Claims Reviewer TriWest Healthcare AllianceSr Claims ReviewerPortland, ORRemoteFull timeProficient with claim and coding tools such as Supercoder, Clinical Decision Support Tool, Current Procedural Terminology, Health Care Financing Administration Common Procedure Coding System, and American Dental coding. This role will serve as a SME and will collaborate with Claims leadership, Training, the Claims Content Specialist, and internal business partners to ensure procedures and training materials are accurate and complete.
CorVel CorpLiability Claims Assistant CorVel CorpLiability Claims AssistantPortland, ORRemote$16.90–$23.42 / hourPay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).
CorVel CorpClaims Assistant CorVel CorpClaims AssistantPortland, ORRemote$15.05–$23.42 / hourPay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).
Liberty Mutual Holding Company IncTechnical Claims Specialist, Workers Compensation - West Region Liberty Mutual Holding Company IncTechnical Claims Specialist, Workers Compensation - West RegionLake Oswego, ORHas developed high level of knowledge of Workers Compensation claims handling techniques, a full knowledge of LMG claims procedures and is cognizant of new industry trends and claim handling techniques Uses available data to track claims trends and other claim related metrics. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role.