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.
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.
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, 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.
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, ORDetermines amounts owed, evaluates settlement value, negotiates with plaintiff counsel and other parties, and authorizes settlements and payments within assigned authority; recommends or issues denials when appropriate. The Claims Specialist works within a Claims Team, using the latest technology to manage a caseload of commercial rideshare, also known as Transportation Network Company (TNC), claims from initial investigation through resolution.
Medical Claims Entry Operator Moda Partners IncMedical Claims Entry OperatorMilwaukie, OR$17.34–$18.92 / hourFor more information regarding accommodations please direct your questions to Kristy Nehler and 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.
Marine Claims Advocate Marsh & McLennan Companies IncMarine Claims AdvocatePortland, OR$100,400–$213,800 / yearDevelops thought leadership materials and drafts communication documents for clients, such as correspondence letters, claims calculations and reviews documents prepared by the clients in order to support highly complex claims process for clients. We will count on you to: Provides coverage and claims strategy advice to clients on claims with highly complex coverage issues that require full range of expertise to solve in order to assist with claims preparation.
Pharmacy 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.
Medical Claims Entry Operator Moda HealthMedical Claims Entry OperatorMilwaukie, OR$17.34–$18.92 / hourFor more information regarding accommodations please direct your questions to Kristy Nehler and 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.
NewWFRP Claims Specialist Sompo International Holdings LimitedWFRP Claims SpecialistOR$70,000–$90,000 / yearThe employee is required to have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading; visual inspection involving small defects, small parts, and/or operation of machines (including inspection); using measurement devices; and/or assembly or fabrication parts at distances close to the eyes. As one of the leading writers of Federal Crop Insurance, AgriSompo North America combines industry experience, resources, capital and talent to deliver both traditional and innovative crop insurance and productivity tools to farmers, ranchers, insurers and agribusinesses in the United States.
Marine Claims Advocate Marsh McLennanMarine Claims AdvocatePortland, Oregon$100,400–$213,800 / yearDevelops thought leadership materials and drafts communication documents for clients, such as correspondence letters, claims calculations and reviews documents prepared by the clients in order to support highly complex claims process for clients. The applicable base salary range for this role is $100,400 to $213,800.The base pay offered will be determined on factors such as experience, skills, training, location, certifications, education, and any applicable minimum wage requirements.
Claims Specialist CorVel Enterprise Claims, Inc.Claims SpecialistPortland, ORRemote$52,999–$85,473 / yearPart timeThe Workers’ CompensationClaims Specialist manages within company best practices lower-level, non-complex and non-problematic workers’ compensation claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims professional, supporting the goals of claims department and of CorVel. Pay 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.
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.
Field Claims Representative - Portland, Oregon Acuity, A Mutual Insurance CompanyField Claims Representative - Portland, OregonPortland, OR$75,000–$150,000 / yearMaintains working relationship with field sales force and underwriting department in securing and giving information on claims and regarding the risk desirability of insureds. The representative evaluates liability, exposure, subrogation potential and arrange for the disposition of claims through settlement or denial, including litigation.
NewClaims 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.
Workers Compensation Claims Consultant Alera Group IncWorkers Compensation Claims ConsultantPortland, ORRemote$80,000–$110,000 / yearService 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.
RN Hospital Claims Auditor Moda Partners IncRN Hospital Claims AuditorPortland, OR$78,911.43–$98,639.28 / yearCollaborates with other Moda areas to provide clinical policy representation at meetings to ensure that decisions, which affect claim processing, are appropriate and will result in cost effective, efficient, and accurate claims payment. Communicates claim payment decisions to processing staff and recommends and coordinates processes to review large dollar hospital claims.
RN Hospital Claims Auditor Moda HealthRN Hospital Claims AuditorPortland, OR$78,911.43–$98,639.28 / yearCollaborate with other Moda areas to provide clinical policy representation at meetings to ensure that decisions which affect claim processing are appropriate and will result in cost effective, efficient, and accurate claims payment. Assist with specific claim reviews such as diagnosis-related group (DRG) validation, appropriate level of care, inpatient readmission, and any opportunities identified by the payment integrity analytical team.
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.