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.
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.
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 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.
Property & Casualty Insurance Claims Operations Consultant, Manager PricewaterhouseCoopers LLPProperty & Casualty Insurance Claims Operations Consultant, ManagerOR$99,000–$232,000 / yearPwC does not intend to hire experienced or entry level job seekers who will need, now or in the future, PwC sponsorship through the H-1B lottery, except as set forth within the following policy: https://pwc.to/H-1B-Lottery-Policy . You will analyze client needs, implement solutions, and provide training and support to validate seamless integration and utilization of business applications, enabling clients to achieve their strategic objectives.
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.
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.
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.
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.
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.
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.
NewESIS Senior Claims Representative, WC Chubb LtdESIS Senior Claims Representative, WCPortland, OR$78,100–$109,400 / 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 industry's broadest selections of risk management solutions covering both pre- and post-loss services.
Senior Claims Specialist I, Workers Compensation - West Region Liberty Mutual Holding Company IncSenior Claims Specialist I, Workers Compensation - West RegionLake Oswego, ORRemoteResponsibilities: Plans and conducts investigations of claims (including such activities as interviewing insureds, witnesses and claimants, collecting and evaluating appropriate documentation and securing evidence and protecting the chain-of-custody) to analyze and confirm coverage and to determine liability, compensability and damages. Demonstrates an advanced knowledge of claims case handling practices, legal liability, general insurance policy coverage, and the state s tort laws as normally acquired through a bachelor s degree (or equivalent training) plus 3 to 5 years directly related work experience.
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.
Claims Specialist, Workers Compensation - West Region Liberty Mutual Holding Company IncClaims Specialist, Workers Compensation - West RegionLake Oswego, ORRemoteResponsibilities: Plans and conducts investigations of claims (including such activities as interviewing insureds, witnesses and claimants, collecting and evaluating appropriate documentation and securing evidence and protecting the chain-of-custody) to analyze and confirm coverage and to determine liability, compensability and damages. As a Workers Compensation Claims Specialist, you will work within a Claims Team, using the latest technology to review, analyze, and process claims that are routinely characterized as moderately complex to complex within assigned authority limits.
Claims Escalation Rep TriWest Healthcare AllianceClaims Escalation RepPortland, ORRemoteFull timeIndependent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; Commitment to task to produce outcomes without direction and to find necessary resources. Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; Detail-oriented.
Director Complex Claims and Counsel Banner HealthDirector Complex Claims and CounselOR$65.70–$109.50 / hourResponsible for obtaining, entering data into claim file and monitoring such data in order to comply with deadlines for meeting Medicare, Medicaid, Ship Extension Act (MMSEA) reporting requirements in relation to claimants and others releasing medical expense claims. Actual pay determined at offer will be based on years of relevant work experience, education, certifications, skills, and geographic location, along with a review of current employees in similar roles to ensure pay equity is achieved and maintained.
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.
NewClaims Adjuster Epitec StaffingClaims AdjusterPortland, OR$47–$52 / 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.
Claims 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.
Pharmacy Technician Supervisor / COE Call Center ResCare Premier Inc.Pharmacy Technician Supervisor / COE Call CenterVancouver, WA$30–$38.50 / hourFull timePharMerica, an affiliate of BrightSpring Health Services, delivers personalized pharmacy care through dedicated local teams, serving health care providers such as skilled nursing facilities, senior living communities, and hospitals. Our Pharmacy group focuses on providing exceptional customer service and meeting the pharmacy needs for hospitals, rehabilitation hospitals, long-term acute care hospitals, and other specialized care centers nationwide.
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.
Claims Adjuster 4 Iconma LLCClaims Adjuster 4Portland, CAStrong 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.
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.
Claims 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 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.
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).
Claims Adjuster 4 ICONMA, LLCClaims 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.
National Litigation & Claims Management Attorney Wilson ElserNational Litigation & Claims Management AttorneyPortland, OregonThe ideal candidate is not only experienced, but agile, someone who can quickly pivot between priorities, manage competing deadlines, and proactively identify risks and opportunities across a complex, multi-jurisdictional docket. We are seeking a highly skilled attorney with deep experience in litigation, claims management, and, critical discovery strategy and execution to support our representation of a large, national logistics services provider.
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.
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.
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.
Claims Specialist CorVel CorpClaims SpecialistPortland, ORRemote$52,999–$85,473 / yearThe Workers' Compensation Claims 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.
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.
Claims 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.
NewClaims Representative - Workers Compensation | Jurisdiction: WA | Licensing: WA - Hybrid Sedgwick Claims Management Services, Inc.Claims Representative - Workers Compensation | Jurisdiction: WA | Licensing: WA - HybridPortland, ORRemoteMental: 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. PRIMARY PURPOSE OF THE ROLE To analyze low level workers compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
NewClaims Examiner - Workers Compensation | Jurisdiction: WA | Licensing: WA - Hybrid Sedgwick Claims Management Services, Inc.Claims Examiner - Workers Compensation | Jurisdiction: WA | Licensing: WA - HybridPortland, ORRemoteMental: 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. PRIMARY PURPOSE OF THE ROLE To analyze workers compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
Senior 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.
Claims Assistant CorVel CorpClaims AssistantPortland, OR$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!).
NewNational Litigation & Claims Attorney - Remote/Hybrid BCG Attorney SearchNational Litigation & Claims Attorney - Remote/HybridPortland, ORRemoteBCG Attorney Search is seeking a National Litigation and Claims Management Attorney in Portland, Oregon, to support a large logistics services provider's legal representation. The ideal candidate will independently handle litigation caseloads, develop strategic discovery responses, and enhance a national claims program, all while collaborating with the legal team.
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/ .
Claims Adjuster Trainee The Progressive CorpClaims Adjuster TraineeTigard, OR$59,500–$63,500 / yearFor ideas about how you might be able to protect yourself from job scams, visit our scam-awareness page at https://www.progressive.com/careers/how-we-hire/faq/job-scams/ . This is a hybrid role, which means you'll work in-office two days that are selected by local leadership and choose where you want to work the other three days, whether that's at home or in the office, for a period of 12 months.
Senior Private Client Services Manager GallagherSenior Private Client Services ManagerLake Oswego, OregonFull timeThe 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. As a Private Client Service Manager at Gallagher, you’ll be the trusted advisor for High Net Worth individuals, managing their personal insurance programs and ensuring their unique needs are met with precision and care.
Disability Case Manager Telus CorpDisability Case ManagerORRemoteOur Absence and Disability Management business helps employers achieve improved health and productivity outcomes with services focused on absence reporting, proactive case management and effective return-to-work support for a variety of employee health risks or conditions, whether related to physical, mental, social or workplace health. Additional course work in occupational health, rehabilitation, legislation related to disability management, helping relationship skills, mediation, human resource management, disability insurance, psychological and workplace factors in disability would be an asset.
Environmental, Health and Safety Divisional Manager Pacific SeafoodEnvironmental, Health and Safety Divisional ManagerClackamas, Oregon4. Document and Compliance Management: Ensure all documents, logs, permits, and required records are organized and maintained in accordance with internal and regulatory requirements, regularly reviewing record retention practices to ensure locations are supported and audit ready. This position collaborates with EHS, location administration, and team members to promote a healthy and safe work environment by leading the safety improvements and injury prevention process to drive a reduction in EHS costs and risk exposure within the division.
NewSenior Client Manager GallagherSenior Client ManagerLake Oswego, OregonFull timeWhether it’s shaping benefit strategies, designing wellbeing programs, or advising on workforce challenges, the work you do here creates meaningful change for businesses and the people who power them. How you'll make an impact : In this role, you’ll ensure our clients receive exceptional service by managing accounts, supporting complex projects, and mentoring colleagues.
Revenue Cycle Manager International Rehabilitative Sciences IncRevenue Cycle ManagerVancouver, WAThe Revenue Cycle Manager will play a key role in both day-to-day revenue cycle operations and the continued expansion of RS Medical into new insurance-billed markets, including workers' compensation, PIP, USDOL, Medicare, and commercial insurance programs. We design and build prescription-grade medical devices that deliver effective pain relief and muscle rehabilitation, helping individuals with severe musculoskeletal conditions access safe, effective treatment when they need it most.