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Insurance Reviewer Jobs in Remote, OR (NOW HIRING)

Umpqua Health

Utilization Review Specialist

Winston, OR · On-site

$41K - $47K/yr

Utilization Review Specialist HYBRID, must be able to travel to 3031 NE STEPHENS ST. ROSEBURG, OR ... Medical, dental, and vision insurance * 401(k) with company match (fully vested immediately)

Umpqua Health

Utilization Review Nurse

Roseburg, OR · On-site +1

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR ... Medical, dental, and vision insurance * 401(k) with company match (fully vested immediately)

Umpqua Health

Utilization Review Nurse

Roseburg, OR · Remote

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR ... Medical, dental, and vision insurance * 401(k) with company match (fully vested immediately)

Therapeutic Associates

Authorization Representative

OR · On-site +1

$17 - $20/hr

Periodically review Physical Therapist charts and other documents to verify correct CPT and ICD codes for claim creation and insurance billing. * Assist TAI Customer Service and Accounts Receivable ...

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Insurance Reviewer information

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How much do insurance reviewer jobs pay per hour?

As of Jul 15, 2026, the average hourly pay for insurance reviewer in Remote, OR is $29.85, according to ZipRecruiter salary data. Most workers in this role earn between $22.60 and $36.49 per hour, depending on experience, location, and employer.

What does a claims reviewer do?

A claims reviewer evaluates insurance claims to determine their validity and ensure they comply with policy terms. They analyze documentation, assess damages or losses, and decide whether to approve, deny, or request additional information, often using specialized software and following company guidelines.

What are some common challenges faced by Insurance Reviewers and how can they be addressed?

Insurance Reviewers often encounter challenges such as interpreting complex policy language, managing high volumes of documentation, and staying updated with frequently changing regulations. To address these, many reviewers develop strong organizational skills, utilize specialized software to streamline document management, and participate in ongoing training or professional development. Collaborating closely with underwriters, claims adjusters, and legal teams also helps ensure accurate and timely policy assessments, reducing the risk of errors.

What position in insurance pays the most?

In insurance, executive roles such as Chief Underwriting Officer, Chief Risk Officer, or Chief Executive Officer typically have the highest salaries. These positions require extensive experience, leadership skills, and often advanced certifications, and they oversee large teams and strategic decision-making within insurance companies.

What skills do you need to be a medical reviewer?

A medical reviewer needs strong knowledge of medical terminology, healthcare regulations, and insurance policies. Critical thinking, attention to detail, and the ability to interpret medical records are essential skills. Often, certifications such as a Registered Nurse (RN) or Physician are required, along with experience in healthcare or insurance industries.

How to get a job as a reviewer?

To become an insurance reviewer, candidates typically need a background in insurance, healthcare, or related fields, along with strong analytical and communication skills. Relevant certifications, such as the Chartered Property Casualty Underwriter (CPCU) or insurance licenses, can improve job prospects. Gaining experience through internships or entry-level roles in insurance companies or claims departments is also beneficial.

What does an Insurance Reviewer do?

An Insurance Reviewer is responsible for evaluating insurance claims, policies, and related documents to ensure compliance with company and regulatory guidelines. They review submitted claims to determine their validity, check for completeness and accuracy, and may communicate with policyholders or healthcare providers for additional information. Insurance Reviewers help prevent fraud, reduce errors, and ensure that claims are processed fairly and efficiently. Their work is crucial in maintaining the integrity and cost-effectiveness of an insurance company's operations.

What are the key skills and qualifications needed to thrive as an Insurance Reviewer, and why are they important?

To thrive as an Insurance Reviewer, you need strong analytical skills, attention to detail, and a solid understanding of insurance policies and regulations, often supported by relevant experience or a degree in business or finance. Familiarity with claims management systems, insurance software, and sometimes certifications like AINS (Associate in General Insurance) are typically required. Excellent communication, problem-solving abilities, and organizational skills help you manage cases efficiently and interact with clients or colleagues. These competencies ensure accurate claim assessments, compliance with industry standards, and high-quality customer service.
What are popular job titles related to Insurance Reviewer jobs in Remote, OR? For Insurance Reviewer jobs in Remote, OR, the most frequently searched job titles are:
What job categories do people searching Insurance Reviewer jobs in Remote, OR look for? The top searched job categories for Insurance Reviewer jobs in Remote, OR are:
Insurance Reviewer jobs near you
Infographic showing various Insurance Reviewer job openings in Remote, OR as of July 2026, with employment types broken down into 1% As Needed, 71% Full Time, 23% Part Time, and 5% Contract. Highlights an 91% Physical, 1% Hybrid, and 8% Remote job distribution, with an average salary of $62,098 per year, or $29.9 per hour.
Utilization Review Specialist

Utilization Review Specialist

Umpqua Health

Winston, OR • On-site

$41K - $47K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 23 days ago

Job description

Utilization Review Specialist
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 Utilization Review Specialist supports Umpqua Health Alliance by coordinating the intake, review, processing, and completion of prior authorization requests within Medical Management. This role is responsible for ensuring accurate and timely handling of authorizations, maintaining compliance with regulatory and organizational requirements, supporting communication with providers and members, and assisting with workflow coordination to promote efficient utilization management operations.
ESSENTIAL JOB RESPONSIBILITIES
  • Support Utilization Review activities related to the prior authorization process.
  • Manage intake, tracking, and routing of prior authorization requests and supporting documentation.
  • Review requests for completeness and ensure appropriate routing for processing.
  • Communicate with healthcare providers to obtain additional information and resolve documentation issues.
  • Track prior authorization requests using established systems to ensure timely processing.
  • Support timely notification of prior authorization determinations.
  • Coordinate daily workflow and telephone coverage with team members.
  • Respond to internal and external inquiries regarding prior authorizations and route as appropriate.
  • Monitor and report on turnaround times to ensure compliance with requirements.
  • Maintain knowledge of applicable regulations, policies, and procedures.
  • Comply with organizational policies and applicable to federal, state, and local regulations.
CHALLENGES
  • Strong organizational skills with the ability to stay organized and productive in a remote, independent work environment
  • Proactive communication with internal and external stakeholders
  • Consistent ability to meet Oregon Health Plan (OHA) timeline and turnaround requirements
  • Ability to manage shifting priorities in a fast-paced environment
  • Ability to coordinate tasks and resources to meet operational goals and objectives
MINIMUM QUALIFICATIONS
  • High school diploma or equivalent.
  • Proficient computer skills, including Microsoft Office Suite (Word, Excel, Outlook, Teams), data entry, and internet research.
  • Experience using standard office equipment and systems, including keyboarding, web-based phone systems, and cloud-based document storage.
  • Ability to type a minimum of 45 words per minute with a high degree of accuracy.
  • Strong attention to detail.
  • No suspension, exclusion, or debarment from participation in federal healthcare programs (e.g., Medicare/Medicaid)
PREFERRED QUALIFICATIONS
  • 1+ years of experience in healthcare, managed care, medical coding, 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), including applicable regulations (OAR, ORS, CFR, CMS, DMAP)
  • Strong organizational skills with the ability to manage multiple priorities in a fast-paced environment
  • Ability to meet deadlines while maintaining accuracy and attention to detail
  • Strong communication and customer service skills (written, verbal, and interpersonal)
  • Ability to work independently and collaboratively with sound judgment and confidentiality
  • Strong critical thinking and time management skills
  • Self-motivated with ability to follow policies, procedures, and workflows in a remote environment
  • Flexible and adaptable in a changing work environment
  • Willingness to learn and take on additional responsibilities as needed
  • Ability to work a standard schedule: Monday-Friday, 8:00 AM-5:00 PM PST
  • Experience working in diverse teams and with varied communication styles
  • Experience considering the impact of work on diverse communities, including communities of color
  • Bilingual or translation skills preferred

SCHEDULE
Monday through Friday - 8:00am - 5:00pm; standard business hours with flexibility to meet service timelines.
SALARY
Wage Band : $41,600- $47,000
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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