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Claims Processing Jobs in Remote, OR (NOW HIRING)

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Claims Service Representative (Remote - Part-Time) (278469)

OR · Remote

$18/hr

Process medical claims and communicate with providers regarding the claims process. Maintain daily claims management, document detailed claim notes, resolve issues, and escalate calls when necessary.

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Loomis

Coin Processor

Roseburg, OR · On-site

$19.69/hr

As a Coin Processor, you work with your team to maintain inventory in our cash vaults for our Loomis customers. Responsibilities: * Count, sort, and handle coin bags weighing 50 pounds * Manage the ...

Douglas County, OR

Veterans Claims Specialist

Roseburg, OR · On-site

$24.38 - $32.15/hr

This position provides support to the Veterans Services Officer by assessing the needs of clients and offering assistance with processing claim forms. Essential Job Duties: This is not an exhaustive ...

Umpqua Health

Utilization Review Specialist

Winston, OR · On-site

$41K - $47K/yr

... claims processing, or a related field * Knowledge of medical terminology, procedure codes, and diagnosis codes * Familiarity with Oregon Health Plan (OHP) and Coordinated Care Organizations (CCO ...

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 ...

CONFEDERATED TRIBES OF CLUSI

Pharmacy Biller

Coos Bay, OR

$17.25 - $22.25/hr

Description The Pharmacy Biller is responsible for the accurate and timely processing of pharmacy billing and reimbursement activities. This role reviews claims, resolves denials, and supports ...

Bekaert

Application Engineer Crane&Industrial

OR · On-site

You bring application expertise directly to the field, resolving quality claims, conducting ... Strong understanding of T&I processes, machinery operation, and production technologies. * Problem ...

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Claims Processing information

See Remote, OR salary details

$12

$19

$26

How much do claims processing jobs pay per hour?

As of Jul 16, 2026, the average hourly pay for claims processing in Remote, OR is $19.15, according to ZipRecruiter salary data. Most workers in this role earn between $16.35 and $20.67 per hour, depending on experience, location, and employer.

What is the difference between Claims Processing vs Claims Adjuster?

AspectClaims ProcessingClaims Adjuster
CredentialsHigh school diploma or equivalent; certifications varyHigh school diploma; often state licensing or certifications
Work EnvironmentOffice-based, administrative settingFieldwork and office-based, investigative environment
Industry UsageInsurance companies, healthcare providersInsurance companies, claims departments
Job FocusReviewing and processing claims for paymentInvestigating claims, determining liability and settlement

Claims Processing involves reviewing and managing insurance claims to ensure proper payment, focusing on administrative tasks. Claims Adjusters investigate claims, assess damages, and determine liability. While both roles work within the insurance industry, Claims Processing is more administrative, whereas Claims Adjusters are investigative and evaluative.

What are some common challenges faced by professionals in claims processing, and how can they be managed effectively?

Professionals in claims processing often deal with high volumes of work, tight deadlines, and complex cases that require attention to detail. Managing these challenges involves staying organized, utilizing claims management software efficiently, and continuously updating knowledge of insurance policies and regulations. Effective communication with team members and other departments is also crucial to resolve discrepancies quickly and ensure accurate claim adjudication. Many organizations offer ongoing training and mentorship to help staff adapt to changes and improve efficiency.

What are the key skills and qualifications needed to thrive as a Claims Processor, and why are they important?

To thrive as a Claims Processor, you need a solid understanding of insurance policies and claims procedures, typically supported by a high school diploma or equivalent and relevant on-the-job training. Familiarity with claims management software, data entry systems, and basic office applications is essential. Strong attention to detail, analytical thinking, and effective communication skills help you resolve claims accurately and efficiently. These skills ensure the timely and proper handling of claims, enhancing customer satisfaction and minimizing errors or fraudulent activity.

What is claims processing?

Claims processing is the procedure by which insurance companies or organizations review and manage claims submitted by policyholders or clients. This involves verifying the details of the claim, ensuring all necessary documentation is provided, assessing the validity of the claim, and determining the appropriate payout or resolution. Claims processors play a crucial role in ensuring claims are handled efficiently, accurately, and in compliance with company policies and regulations.
What are the most commonly searched types of Claims Processing jobs in Remote, OR? The most popular types of Claims Processing jobs in Remote, OR are:
Claims Processing jobs near you
Infographic showing various Claims Processing job openings in Remote, OR as of July 2026, with employment types broken down into 89% Full Time, 8% Part Time, and 3% Contract. Highlights an 86% Physical, 4% Hybrid, and 10% Remote job distribution, with an average salary of $39,824 per year, or $19.1 per hour.
Contracting Specialist Benefits and Claims

Contracting Specialist Benefits and Claims

Umpqua Health

Roseburg, OR • On-site

$84K - $95K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 23 days ago

Job description


CONTRACTING SPECIALIST BENEFITS AND CLAIMS
HYBRID, must be able to travel to 3031 NE STEPHENS ST. ROSEBURG, OR 97470
EMPLOYMENT TYPE: Full-Time, Exempt
 

About Umpqua Health
At Umpqua Health, we’re more than a healthcare organization—we’re a community-driven Coordinated Care Organization (CCO) dedicated to improving the health and well-being of individuals and families throughout Douglas County, Oregon. We provide integrated, whole-person care through primary care, specialty care, behavioral health services, and care coordination. Our collaborative approach ensures members receive high-quality, personalized care while supporting a stronger, healthier community.
POSITION PURPOSE
The Benefit and Claims Oversight Specialist is responsible for ensuring accurate, timely, and compliant administration of health plan benefits and claims through Umpqua Health’s Third-Party Administrator (TPA). This role does not supervise internal staff but holds full oversight responsibility for TPA performance, compliance, and adherence to contractual and regulatory requirements. The position also manages provider contract distribution, benefit administration communications, and interpretation of contract requirements. Acting as the primary liaison between Umpqua Health and the TPA, this role drives accountability, resolves claims issues, and supports organizational goals for quality and efficiency.
ESSENTIAL JOB RESPONSIBILITIES
TPA Oversight & Compliance
  • Oversee Third-Party Administrator (TPA) performance, ensuring accuracy, timeliness, and adherence to service-level agreements.
  • Lead audits and compliance reviews to ensure alignment with federal and state regulations, contractual obligations, and organizational standards.
  • Manage and resolve escalated claims and benefit issues, ensuring timely and effective outcomes.
Provider Contract & Benefit Administration
  • Oversee distribution, tracking, and validation of provider contracts to ensure accuracy and compliance.
  • Interpret and operationalize Oregon Health Authority (OHA) and Umpqua Health Network (UHN) contractual requirements.
  • Ensure accurate configuration and maintenance of benefits, fee schedules, and authorization rules within claims systems.
  • Direct data integrity efforts across TPA and internal systems, ensuring consistent application of business rules.
Claims Oversight & Issue Resolution
  • Provide leadership in the resolution of complex claims issues, disputes, and exceptions.
  • Ensure accurate interpretation and application of benefit structures by the TPA.
  • Serve as a key escalation point for internal teams and external partners.
Process Improvement & Policy Management
  • Develop and implement policies and procedures to strengthen claims oversight and benefit administration.
  • Identify operational gaps and lead process improvement initiatives to enhance efficiency, accuracy, and compliance.
Reporting & Stakeholder Communication
  • Serve as the primary liaison for TPA-related performance and escalation matters.
  • Deliver regular reporting, insights, and strategic recommendations to leadership.
  • Perform other duties as assigned.

CHALLENGES
  • Working with a variety of personalities, maintaining a consistent and fair communication styles.
  • Satisfying the needs of a fast-paced and challenging company.

MINIMUM QUALIFICATIONS
  • Bachelor’s degree in healthcare administration, Business, or a related field required
  • Minimum of 5 years of experience in health plan claims processing and benefit administration, preferably with TPA oversight responsibilities
  • Strong understanding of managed care operations and regulatory compliance
  • Proficiency in claims systems and Microsoft Office Suite
  • Strong analytical and problem-solving skills
  • Excellent verbal and written communication skills, including negotiation abilities
  • Ability to manage vendor relationships and enforce accountability
  • Ability to analyze and interpret data to determine appropriate configuration changes
  • Ability to accurately interpret state and/or federal benefits, contracts, and additional business requirements and translate them into configuration parameters
  • Ability to coordinate and facilitate coding updates related to benefit plans, provider contracts, fee schedules, and system tables through the user interface
  • Ability to apply previous experience and knowledge to research and resolve claim and encounter issues, including pended claims, and communicate system update needs to TPAs
  • Ability to manage fluctuating workloads and prioritize tasks to meet deadlines and the needs of the user community
  • Demonstrated accountability, integrity, innovation, and collaboration in a professional setting
PREFERRED QUALIFICATIONS
  • Certified Coder (preferred)
  • Bilingual translation or translation capabilities a plus
SCHEDULE
Monday through Friday - 8:00am - 5:00pm; standard business hours with flexibility to meet service timelines.
SALARY
Wage Band: $84,000-95,900
BENEFITS
  • Salary is dependent on skills, experience, and education
  • Generous benefits package including vacation PTO, sick leave, federal holidays, and birthday leave
  • Medical, dental, and vision insurance
  • 401(k) with company match (fully vested immediately)
  • Company-sponsored life insurance and additional benefits
  • Fitness reimbursement program
  • Tuition reimbursement and more

Why Umpqua Health?
We are committed to advancing health equity by collaborating across communities, addressing systemic barriers, and ensuring fair access to care and resources. At Umpqua Health, every team member plays a vital role in making a meaningful impact, empowering healthier lives and strengthening the communities we serve.
Inclusive Culture
We foster a respectful, inclusive environment where employees feel valued, supported, and empowered.
Growth & Development
We support ongoing learning through mentorship, clear career pathways, and professional development opportunities.
Work/Life Balance
We promote flexibility and well-being so employees can thrive both professionally and personally.
Equal Opportunity
Umpqua Health is an equal opportunity employer that embraces individuals from all backgrounds. We prohibit discrimination and harassment of any kind, ensuring that all employment decisions are based on qualifications, merit, and the needs of the business. Our dedication to fairness and equality extends to all aspects of employment, including hiring, training, promotion, and compensation, without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, veteran status, or any other protected category under federal, state, or local law.

 

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