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Insurance Appeals Jobs in Oregon (NOW HIRING)

Centene

Clinical Appeals Coordinator

OR · On-site +1

$33.71 - $60.67/hr

Act as the liaison for all statewide appeals, fair hearings, review organizations, and other ... pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus ...

Centene

Remote Medical Director, Appeals

OR · On-site +1

$236K - $449K/yr

Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy ... Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel ...

Kairos

Insurance Coordinator

Grants Pass, OR · On-site

... appeals Client & Team Support * Provide clear, compassionate explanation of insurance benefits to clients * Support clinicians and scheduling staff with insurance-related questions * Maintain ...

Kairos

Insurance Coordinator

Grants Pass, OR · On-site

... appeals Client & Team Support * Provide clear, compassionate explanation of insurance benefits to clients * Support clinicians and scheduling staff with insurance-related questions * Maintain ...

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Insurance Appeals information

What are insurance appeals?

Insurance appeals are formal requests made to an insurance company to reconsider and potentially overturn a denied claim or coverage decision. When an insurance provider refuses to pay for a service or treatment, policyholders or healthcare providers can submit an appeal with supporting documentation to argue why the claim should be approved. The appeals process typically involves several steps and may require detailed medical records, letters from healthcare professionals, and a clear explanation of why the original decision should be reversed.

What are the key skills and qualifications needed to thrive in insurance appeals?

To thrive in Insurance Appeals, you need a solid understanding of insurance policies, claims processes, medical terminology, and relevant regulations, often supported by experience in healthcare administration or a related field. Familiarity with claims management software, electronic health records (EHRs), and knowledge of HIPAA compliance are typically required. Strong analytical skills, attention to detail, and effective written and verbal communication set outstanding professionals apart. These skills are crucial for efficiently navigating complex appeals, ensuring compliance, and achieving positive outcomes for clients or organizations.

What are some common challenges faced in an insurance appeals role, and how can they be managed?

Professionals in Insurance Appeals often encounter challenges such as navigating complex policy guidelines, handling tight deadlines, and managing extensive documentation requirements. Staying organized and up-to-date on insurance regulations is essential to ensure accurate and timely submissions. Collaborating closely with medical providers, patients, and insurance representatives can help clarify information and strengthen appeal cases. Effective time management and clear communication are key to overcoming these challenges and achieving successful outcomes.

What are popular job titles related to Insurance Appeals jobs in Oregon?

For Insurance Appeals jobs in Oregon, the most frequently searched job titles are:

What job categories do people searching Insurance Appeals jobs in Oregon look for?

The top searched job categories for Insurance Appeals jobs in Oregon are:

Insurance Appeals jobs near you
Infographic showing various Insurance Appeals job openings in Oregon as of August 2026, with employment types broken down into 1% As Needed, 72% Full Time, 22% Part Time, and 5% Contract. Highlights an 85% Physical, 1% Hybrid, and 14% Remote job distribution.

Clinical Appeals Coordinator

OR • On-site, Remote

Centene
Health Care and Social Assistance • 10K+ employees

8.4

Company rating: 8.4 out of 10

Based on 405 frontline employees who took The Breakroom Quiz

14th of 894 rated healthcare providers

People enjoy working here

Good employer

Recommended by students

Learn more about Centeneexternal

$33.71 - $60.67/hr

Full-time

Medical, Retirement, PTO

This job post has expired 3 days ago. Applications are no longer accepted.

Job description

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

RN, LVN/LPN - Licensed in Oregon

Pacific Time Work Hours

Position Purpose:
Act as the liaison for all statewide appeals, fair hearings, review organizations, and other external type appeals. Responsible for ensuring that all appeal letters generated comply with both State and NCQA requirements.

  • Review clinical information for all appeals utilizing nationally recognized criteria to determine medical necessity of services requested.
  • Prepare reviews for cases that did not meet criteria
  • Gather, analyze and report verbal and written information regarding member and provider clinical appeals, including information follow up
  • Prepare response letters for member and provider clinical appeals and ensure letters are compliant with State and NCQA standards.
  • Maintain files and logs for all appeals
  • Coordinate with Medical Director(s) to clarify medical determinations or clinical rationale
  • Maintain current knowledge of NCQA and State regulations
  • Coordinate Fair Hearings with various internal departments and agencies
  • Performs other duties as assigned
  • Complies with all policies and standards

Education/Experience:
RN with 4+ years of clinical nursing and/or case management experience or LPN/LVN with 5+ years of clinical nursing or case management experience. Managed care or utilization review experience preferred.
License/Certification: LPN, LVN, or RN license.
Specialty Therapy Requirement: Master's degree in area of specialty therapy or equivalent experience. 3+ years of experience providing therapy services in healthcare or home health settings. Managed care or utilization review experience preferred.

Pay Range: $33.71 - $60.67 per hour

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.


Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

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