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.
Pharmacy 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.
Complex Claims Consultant - Epl, Private & NFP D&O CNA Financial Corp.Complex Claims Consultant - Epl, 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.
NewClaims Analyst I (Analyst I - CPPW) City of Portland, OregonClaims Analyst I (Analyst I - CPPW)Portland, ORRemote$40.97–$58.47 / hourExperience establishing and maintaining effective working relationships with diverse internal and external stakeholders, such as employees, legal counsel, managers, claimants, members of the public, and others encountered in the course of claims administration. Risk Management administers the City's self-insured general liability and workers' compensation programs, procures commercial insurance for property and other risks, and supports City bureaus with employee safety, loss prevention, risk assessment, and third-party subrogation.
NewRN 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.
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.
Operations Manager - Debit Fraud & Dispute Claims US BankOperations Manager - Debit Fraud & Dispute ClaimsGresham, OR$75,820–$89,200 / yearIn 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. Leads high performance teams of both entry level and skilled professionals by setting goals, providing ongoing feedback, measuring progress while recognizing success and building accountability with employees.
Claims Appraiser - Auto Estimatics State FarmClaims Appraiser - Auto EstimaticsPortland, Oregon$63,089.65–$82,000 / yearFull timeWith 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).
NewMarine Claims Advocate Marsh McLennanMarine Claims AdvocatePortland, OregonDevelops 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. Leads highly complex claims process for clients, leads detailed client claim review meetings and participates in claims strategy discussions in order to ensure progress from notification through to closure.
NewMarine 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.
Claims Assistant Western Partitions, Inc.Claims AssistantWilsonville, OR$50,000–$75,000 / yearThe Claims Assistant supports the Claims Manager with the administrative, documentation, communication, and tracking tasks necessary to manage workers' compensation, general liability, auto, OCIP, and CCIP claims from initial report through closure. Help coordinate early Return to Work efforts by tracking work status updates, modified-duty documentation, carrier communication, modified-duty payroll reports, and follow-up items as directed by the Claims Manager.
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.
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.
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.
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.
Claims Contract Attorney Paradigm Information Services, Inc.Claims Contract AttorneyPortland, ORRemoteSupervisors may oversee approximately 10–20 cases, 20–30 team members, and multiple Leads, with greater responsibility for team performance, productivity, escalations, employee development, and client communication. This role provides a potential path into increasingly responsible leadership positions based on performance, business needs, and demonstrated leadership ability.
Claims Assistant Western PartitionsClaims AssistantWilsonville, OregonThe Claims Assistant supports the Claims Manager with the administrative, documentation, communication, and tracking tasks necessary to manage workers’ compensation, general liability, auto, OCIP, and CCIP claims from initial report through closure. Help coordinate early Return to Work efforts by tracking work status updates, modified-duty documentation, carrier communication, modified-duty payroll reports, and follow-up items as directed by the Claims Manager.
NewRN 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.
Outside Property Associate Claim Representative The Travelers CompaniesOutside Property Associate Claim RepresentativeCanby, OR$52,600–$86,800 / yearThis position requires the individual to access and inspect all areas of a dwelling or structure, which is physically demanding requiring the ability to carry, set up and climb a ladder weighing approximately 38 to 49 pounds, walk on roofs, and enter tight spaces (such as attic staircases and entries, crawl spaces, etc.). As an Associate Claim Rep, Outside Property, you will receive comprehensive training in claim handling, customer service, and policy interpretation while working alongside experienced claim professionals.