Job Title: Claims Processor
Worksite Address: Portland, OR 97232
Employment Type: 9 Month Temp‐to‐Hire
Pay Rate: $24-26/hour (based on experience)
Start Date: ASAP
Interview Process:
- One round virtual interview with Claims team
- Second round in-person with higher management
Job Description:
Our client is seeking a Claims Processor to support a long‐standing benefits organization. This role supports U.S. Benefits, a small, experienced claims processing team within a multi‐employer trust environment. This position is open due to upcoming retirements of senior claims processors and will play a key role in claims processing, auditing, adjudication logic, and knowledge transfer. The ideal candidate has strong medical and/or dental claims experience and is comfortable working in a lower‐volume, high‐accuracy environment.
Responsibilities:
Process medical and/or dental claims across the full lifecycle:
- Intake and review
- Data entry and validation
- Claims adjudication
- Follow‐ups and issue resolution
- Appeals processing
- Final claims resolution
- Audit claims processed by other team members
- Apply adjudication logic and benefit plan rules accurately
- Support claims system configuration and processing logic
- Assist with reporting, data needs, and coding requirements
- Respond to member and provider inquiries via phone and email (moderate volume)
- Collaborate with internal teams to ensure compliance and accuracy
- Maintain detailed documentation and adhere to regulatory requirements
Claims Volume:
- A few thousand claims per month that is shared across a 3–4 person team
- Emphasis on quality and accuracy over high volume
Must‐Have Qualifications:
- 2+ years of medical and/or dental claims processing experience
- 1+ Years of experience with claims adjudication logic and appeals
- 1+ years of experience auditing claims and ensuring compliance
- Familiarity with claims processing systems and configuration tools
- Experience handling customer inquiries via phone and email
- High attention to detail and ability to work independently
- Comfortable working in a small team environment
Nice‐to‐Have / Pluses:
- Experience with reporting and data analysis related to claims
- Coding or system configuration experience
- Background in multi‐employer trusts or benefits administration
- Experience supporting process improvement initiatives
Work Schedule:
- Monday–Friday
- Hours: 8:00 AM – 5:00 PM
- 40 hours/week