Claims Processor Zenith American SolutionsClaims ProcessorPortland, OregonWe are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day. Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide.
Inpatient 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.
Medical 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.
Dental 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.
Medical 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.
Supervisor, Healthcare Services Claims Moda Partners IncSupervisor, Healthcare Services ClaimsPortland, 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.
Supervisor, 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.
Supervisor, Healthcare Services Claims - Internal Applicants Only Moda HealthSupervisor, Healthcare Services Claims - Internal Applicants OnlyPortland, 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.
Medical 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.
NewPharmacy Technician - Claims Review Consonus PharmacyPharmacy Technician - Claims ReviewPortland, OregonFull timeAs the Claims Review Specialis t, 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.
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.
Insurance 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!
Spv 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.
Business 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.
Pharmacy 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.
Policy & 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.
Claims Specialist - Rideshare Commercial Auto - Attorney Represented Bodily Injury Claims Adjuster Liberty Mutual Holding Company IncClaims Specialist - Rideshare Commercial Auto - Attorney Represented Bodily Injury Claims AdjusterORAssesses 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.
Claims Specialist II - Rideshare Commercial Auto - Attorney Represented Bodily Injury Claims Adjuster Liberty Mutual Holding Company IncClaims Specialist II - 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.
NewPharmacy Claims Review Manager Consonus PharmacyPharmacy Claims Review ManagerPortland, OregonFull timeThe Pharmacy Claims Manager partners closely with Billing, Customer Accounts, and Pharmacy Operations to ensure accurate reimbursement and compliance, minimize claim write-offs, and ensure exceptional service to residents, facilities, and payers. As the Pharmacy Claims Manager your responsibilities will include (but are not limited to): The Pharmacy Claims Manager is responsible for overseeing all pharmacy claims processing operations, including prescription adjudication, third-party billing, claim rejection management, and reimbursement optimization.
Claims and Risk Manager Brown & Brown IncClaims and Risk ManagerPortland, ORThe Claims and Risk Manager develops and implements comprehensive risk management strategies, advocates for clients throughout the claims process, and collaborates with internal teams and external partners to ensure effective, compliant, and client-focused service delivery. Recruiting Vendors must have a valid written agreement and received prior written authorization from an authorized Brown & Brown representative before submitting candidates for any publicly posted role.
Claims Examiner/Member Services Representative United Employers Association and its AffiliatesClaims Examiner/Member Services RepresentativePortland, ORFull timeSmall 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.
Medical Claims Clerk I Moda HealthMedical Claims Clerk IMilwaukie, ORScan 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.
WC Claims Consultant Alera GroupWC Claims ConsultantPortland, OregonParticipate with or without Sales Executives in presentations to current clients, prospects, proposals, and RFP presentations. Provide assistance to clients seeking to enhance their return-to-work programs and light duty return to work opportunities.
NewClaims Adjuster Epitec StaffingClaims AdjusterPortland, ORThis role requires strong analytical, communication, and decision-making skills to evaluate claims, determine liability, negotiate settlements, and ensure timely claim resolution while maintaining compliance with applicable policies and regulations. Conduct thorough investigations by gathering facts, interviewing claimants, insureds, witnesses, attorneys, medical providers, and other relevant parties.
Claims 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.
Claims Appraiser - Auto Estimatics State FarmClaims Appraiser - Auto EstimaticsPortland, OR$59,059.65–$82,000 / yearWith the opportunity to initially earn up to 20 days annually plus parental leave, paid holidays, celebration day, life leave (40 hours/year), bereavement leave, and community service/education support days, there will be plenty of time for you! Additional Details: Employees must successfully complete all required training, including applicable proficiency, licensing exam(s), Motor Vehicle Record (MVR) checks, and background checks required of various state(s).
Supervisor 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.
Lead 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.
Claims Supervisor CorVel Enterprise Claims, Inc.Claims SupervisorPortland, ORRemote$73,345–$113,247 / yearPart timePay 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. CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries.
Senior Workers Compensation Claims Adjuster - OR/WA GallagherSenior Workers Compensation Claims Adjuster - OR/WAPortland, OregonRemoteFull timeAbout you : Ideal candidates for this position will have: • Claims Background: A minimum of 3-5 years experience handling lost time/indemnity claims and have extensive experience with litigated files • Jurisdictional Experience: OR, WA • Active Adjusters' licenses : OR, WA As a key member of our experienced Claims Adjuster team, you will: The actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours.
NewClaims Associate - Workers Comp. AvenicaClaims Associate - Workers Comp.Portland, ORContact, interview, and obtain statements from insureds, claimants, witnesses, physicians, attorneys, police officers, and other relevant parties to secure necessary claim information. Our customer is a financially stable, nationally recognized employer of choice with offices in major U.S. cities and a strong track record of developing early-career talent.
Claims 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.
Supervisor, 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.
Sr. 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).
Workers Compensation - Sr Consultant Casualty Claims - Southwest The Hanover Insurance Group IncWorkers Compensation - 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.
NewClaims Examiner- Voluntary Benefits Accenture PlcClaims Examiner- Voluntary BenefitsBeaverton, ORAble to utilize strong organizational skills to manage multiple priorities while working under tight time constraints, possess the ability to work through ambiguity, and work effectively with various vendors with strong interpersonal skills. The Voluntary Benefits Claims Examiner will support a large Group Insurance Business contract is responsible for the calculation of Voluntary Benefits across limited products according to Plan Provisions.
NewSupplemental Claims Examiner Standard Insurance CompanySupplemental Claims ExaminerPortland, ORWith a customer-first mindset and an intentional focus on building strong teams, we've been able to uphold our legacy of financial stability while investing in new, innovative technologies that support the needs of our customers. The role also contributes to continuous improvement by bringing forward customer insights, identifying process gaps, and collaborating with teammates to enhance the overall claims experience.
Claims 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/ .
Financial 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.
Claims Director(WC & TPA Oversight) CNA Financial CorpClaims Director(WC & TPA Oversight)Portland, OR$97,000–$189,000 / yearJOB DESCRIPTION: Essential Duties & Responsibilities: Performs a combination of duties in accordance with departmental guidelines: Leads the work activities of claims professionals and/or claims managers and has full management responsibility for setting and communicating expectations, providing direction and coaching, facilitating ongoing training and development, managing employee performance and contributing to employee engagement. This director-level role operates under general direction with broad authority to lead the oversight of complex, high-exposure commercial Workers' Compensation claims managed by Third-Party Administrators (TPAs), while also managing and developing a team of claim professionals.
NewClaims Adjuster 4 IconmaClaims Adjuster 4Portland, CA$16.50–$45.32 / hourStrong communication and interpersonal skills to effectively interact with claimants, customers, insureds, brokers, attorneys, etc., in a positive manner regarding losses. Contacts, interviews and obtains statements from insureds, claimants, witnesses, physicians, attorneys, police officers, etc. to secure necessary claim information.
Sr 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.
Claims 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!).
ESIS Claims Associate Chubb LtdESIS Claims AssociatePortland, OR$47,500–$67,500 / 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 operations in 54 countries, Chubb provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance, and life insurance to a diverse group of clients.
NewClaims Consultant, Life Sciences CNA Financial CorpClaims Consultant, Life SciencesPortland, OR$72,000–$141,000 / yearPerforms a combination of duties in accordance with departmental guidelines: Manages an inventory of highly complex commercial claims with large exposures that require a high degree of 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 complex manage litigation and authorizing payments within scope of authority.
Complex Claims Consultant - Private & NFP D&O CNA Financial CorpComplex Claims Consultant - Private & NFP D&OOR$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.
NewClaims Examiner - 4 Sunrise Systems IncClaims Examiner - 4Portland, ORStrong communication and interpersonal skills to effectively interact with claimants, customers, insureds, brokers, attorneys, etc., in a positive manner regarding losses. Contacts, interviews and obtains statements from insureds, claimants, witnesses, physicians, attorneys, police officers, etc. to secure necessary claim information.
NewClaims Examiner-4 Sunrise Systems IncClaims Examiner-4Portland, ORStrong communication and interpersonal skills to effectively interact with claimants, customers, insureds, brokers, attorneys, etc., in a positive manner regarding losses. Contacts, interviews and obtains statements from insureds, claimants, witnesses, physicians, attorneys, police officers, etc. to secure necessary claim information.
Claims Supervisor CorVel CorpClaims SupervisorPortland, ORRemote$73,345–$113,247 / yearPay 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. CorVel, a certified Great Place to Work Company, is a national provider of industry-leading risk management solutions for the workers' compensation, auto, health and disability management industries.
Workers Compensation Claims Examiner | SIP Required Sedgwick Claims Management Services, Inc.Workers Compensation Claims Examiner | SIP RequiredORRemote$80,000–$100,000 / yearPRIMARY PURPOSE: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.