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Adjudication Jobs in Oregon (NOW HIRING)

Point C

OR · On-site

Ensure all plan configurations support auto adjudication and meet regulatory and compliance requirements. * Regularly review and update plan configurations to reflect changes in healthcare policies ...

Cotiviti

Experience in US healthcare health plan operations (pre-adjudication, post adjudication or adjudication) preferred. * Implementations/transitions experience preferred. * Exceptional operational ...

Personify Health

Sr. Manager of Healthcare Claims - TPA

$107K - $140K/yr

Oversee pended, high-dollar, and special-handling cases from start to finish, ensuring timely, accurate adjudication that meets established policies and service standards. * Resolve escalated issues ...

Personify Health

Sr. Manager of Healthcare Claims - TPA

$107K - $140K/yr

Oversee pended, high-dollar, and special-handling cases from start to finish, ensuring timely, accurate adjudication that meets established policies and service standards. * Resolve escalated issues ...

Greenberg-Larraby, Inc. (GLI)

OR · On-site

$166K/yr

Offers of employment are contingent upon a thorough interview process, background check, and security clearance adjudication processing as applicable. Thank you. * Health Care Plan (Medical, Dental ...

Prescryptive

OR · On-site

$232K - $243K/yr

S. healthcare system - from prescriber initiation toePrescriptionrouting, benefit verification, adjudication, pharmacy fulfillment, and patient access.The ideal candidate also brings direct ...

HealthEdge

Payment integrity * Healthcare plan operations (e.g., claim adjudication life cycle/workflows, network contracting, payment/policy related configuration, provider relations, medical management ...

Team8

Bluespine-Sr. FWA Analyst

OR · On-site +1

... claims adjudication processes, member contract benefits, regulatory agency policies (CMS/HCFA, DOI, state regulations), and provider billing systems and practices. * Strong analytical skills and ...

Puyenpa Services LLC

Armed Security Guards

Umatilla, OR · On-site

$17 - $21.50/hr

Tier 3 adjudicated investigation. * Weapons Qualifications: Both Oregon and Washington Qualifications. Puyenpa provides a variety of benefits including company-paid health, dental & vision insurance ...

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Adjudication information

What is adjudication?

An adjudication job involves reviewing and analyzing claims, applications, or cases to determine eligibility, compliance, or resolution based on established guidelines and policies. Adjudicators work in various fields such as insurance, legal disputes, government benefits, and background checks. Their role includes reviewing documents, verifying information, and making impartial decisions to ensure fair outcomes. Strong attention to detail, analytical skills, and knowledge of relevant regulations are essential for this role.

What are the common responsibilities of adjudication?

Professionals working in Adjudication are responsible for reviewing claims, appeals, or disputes to determine their eligibility or validity based on established guidelines and regulations. Daily tasks often include gathering and analyzing evidence, preparing detailed reports, and communicating decisions to involved parties while ensuring compliance with all applicable laws and policies. Adjudicators also collaborate frequently with internal teams such as customer service, legal, and compliance departments to ensure thorough and accurate decision-making. This role often involves managing multiple cases simultaneously, making strong organizational and time-management skills essential for success.

What are the key skills and qualifications needed for adjudication?

To excel in an Adjudication role, candidates typically need strong analytical abilities, attention to detail, and a background in legal, insurance, or compliance fields, often supported by a relevant degree or professional certification. Familiarity with case management systems, claims processing software, and regulatory databases is commonly required. Excellent problem-solving, communication, and impartial decision-making skills help professionals stand out in this position. These attributes are critical for ensuring fair, consistent, and efficient resolutions in complex claims or disputes.

What are popular job titles related to Adjudication jobs in Oregon? For Adjudication jobs in Oregon, the most frequently searched job titles are:
What job categories do people searching Adjudication jobs in Oregon look for? The top searched job categories for Adjudication jobs in Oregon are:
What cities in Oregon are hiring for Adjudication jobs? Cities in Oregon with the most Adjudication job openings:
Adjudication jobs near you
Infographic showing various Adjudication job openings in Oregon as of August 2026, with employment types broken down into 100% Full Time. Highlights an 67% In-person, and 33% Remote job distribution.

Plan Build Coordinator

Point C

OR • On-site

Other

Posted 8 days ago

Job description

We are seeking a highly skilled and motivated addition to our Plan Building and System Configuration team to optimize auto adjudication processes across all systems. The ideal candidate will have hands-on experience in plan building, system configuration, and claims testing in the healthcare industry. This role requires a dynamic individual who can manage multiple systems, learn and integrate new technologies, and build and test updates to ensure efficient and accurate claims processing.

Primary Responsibilities:

  • Develop, configure, and maintain healthcare plan designs and benefit configurations in various systems.
  • Ensure all plan configurations support auto adjudication and meet regulatory and compliance requirements.
  • Regularly review and update plan configurations to reflect changes in healthcare policies and regulations.
  • Oversee the integration and interoperability of different healthcare systems to streamline auto adjudication processes.
  • Facilitate system upgrades, patches, and maintenance to ensure seamless operation and minimal downtime.
  • Collaborate with IT and other departments to implement new technologies and enhancements.
  • Perform comprehensive testing of plan configurations to ensure accurate and efficient claims adjudication.
  • Identify and resolve any discrepancies or issues in the adjudication process.
  • Create and document testing protocols and procedures to maintain high standards of quality and accuracy.
  • Work closely with internal and external stakeholders to gather requirements and ensure plan configurations meet organizational and client needs.
  • Become a subject matter expert on plan building and system configuration, providing guidance and support to other departments.
  • Communicate effectively with stakeholders to keep them informed of project status, issues, and resolutions.
  • Maintain detailed documentation of all plan configurations, system changes, and testing procedures.
  • Use data and analytics to identify trends, opportunities for improvement, and areas needing attention.

Qualifications:

  • Associate's degree in healthcare administration, information systems, or a related field.
  • Minimum of 2 years of experience in plan building, system configuration, and claims adjudication in the healthcare industry.
  • Strong knowledge of healthcare policies, regulations, and compliance requirements.
  • Proficiency in using healthcare management systems and software.
  • Excellent problem-solving skills and attention to detail.
  • Effective communication and interpersonal skills.
  • Ability to work in a fast-paced environment and manage multiple projects simultaneously.
  • Experience with auto adjudication systems and technologies preferred.
  • Certification in healthcare information systems or related fields preferred.
  • Proven track record of successful system integration and optimization projects preferred.

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