Health Insurance Analyst, Administrative Specialist 1

Health Insurance Analyst, Administrative Specialist 1

The Oregon Department of Human Services is proud to be an Equal Opportunity Employer. We are guided by our Equity North Star and our vision for a positive RiSE organizational culture that advances equity and diversity. We encourage applications from members of historically underrepresented racial / ethnic groups, women, individuals with disabilities, veterans, LGBTQIA2S+ community members, and others to help us achieve our vision of a diverse and inclusive community.

Opportunity awaits! We're in search of leaders committed to promoting and fostering a diverse and qualified workforce where individuals feel welcome, appreciated, and valued for all they bring to the organization. If this position aligns with your skills and career goals, consider taking on a key role in our team as the Health Insurance Analyst, Administrative Specialist 1, with the Health Insurance Group (HIG) Office of Payment Accuracy and Recovery (OPAR), for the Oregon Department of Human Services (ODHS).

Summary of Duties

As a Health Insurance Analyst, you will :

The primary purpose of the Health Insurance Group (HIG) is to ensure that third party resource information for ODHS and OHA clients is entered accurately and timely into the Medicaid Management Information System (MMIS). This unit is responsible for reviewing, researching, analyzing, verifying, and entering third-party medical resources. These efforts contribute to the cost avoidance of Medicaid expenditures, recovery of funds paid in error, and ensure the accurate and timely processing of claims. This unit is also responsible for removing exemptions that prevent Medicaid clients from enrolling in Managed Care plans when it is determined they no longer have an active major medical third-party resource (TPR). This process ensures clients receive the appropriate level of benefits available to them.

Independently review, analyze, and research third-party resource (TPR) referrals and documentation to ensure completeness, determine information for processing, and assess appropriateness for entry into the Medicaid Management Information System (MMIS).

Evaluate whether sufficient information is available to contact the insurance carrier for verification. If not, research historical information, using resources such as the ONE Worker Portal, DMV screens, FRANCES, and OVERS to identify potential third-party resources (TPR). If the necessary information cannot be verified in a timely manner, the referral is returned to the original source.

Research insurance carrier websites to gather third-party resource (TPR) information. Review and analyze the data to determine whether it meets the criteria for entry into the Medicaid Management Information System (MMIS), or if additional details are required to complete the referral.

Minimum Qualifications

Two years of secretarial or basic administrative support experience that includes records processing, generating documents, and gathering and sorting data; OR

An associate degree in general office occupations and one year of experience with records processing, generating documents, and gathering and sorting data; OR

An equivalent combination of education and experience.

Essential Attributes

Experience coordinating health insurance benefits.

Experience in operating medical billing systems via computer terminal.

Experienced in researching, entering, updating, and retrieving alphanumeric data with accuracy and efficiency.

Proficient in communicating effectively with individuals via telephone, written correspondence, and in-person interactions.

Demonstrated strong attention to detail in reviewing, verifying, and processing information.

Attention all candidates! A cover letter is required (limit : 2 pages or less). Clearly describe how you meet the minimum qualifications and essential attributes in your application materials. Your application materials will determine if you are selected to move forward in the selection process. Please include detailed work and education history. Failure to submit the required cover letter will result in disqualification of your application.

Please make sure your application materials, resume and job history, are clearly outlined as this information will be used to determine your starting salary range. If you are selected as the final candidate and a degree is listed as a minimum qualification for the position, please be prepared to provide verification of your completed education before moving forward in the hiring process.

The use of outside resources such as Artificial Intelligence software during applicant skill assessments, examinations, and / or interviews is prohibited unless otherwise stated by the hiring agency. Unauthorized use of outside resources during the hiring process will result in disqualification.

The State of Oregon does not request or require your age, date of birth, attendance or graduation dates from an educational institution during the application process.

Working Conditions

You may be required to come into the office in Salem quarterly for meetings, trainings, business or operational needs.

The working hours for this position are 8 : 00am to 5 : 00pm, Pacific Standard Time.

Work is performed in a typical office or home office setting, involving extended periods of sitting for computer and phone work.

The role is primarily independent, with limited peer-to-peer interaction. Communication with team members occurs mainly through Microsoft Teams Instant Messaging, with weekly virtual meetings conducted via MS Teams using cameras, headsets, or mobile devices.

The position occasionally involves phone or email interactions with individuals who may be upset, emotional, or confrontational.

About the Office of Payment Accuracy and Recovery (OPAR)

The Office of Payment Accuracy and Recovery (OPAR) is part of the Oregon Department of Human Services Shared Services Section. Shared Services is also responsible for Facilities; Imaging and Records Management Services; Occupational Health, Safety and Emergent Management; Office of Information Services; Office of Training, Investigations and Safety; Office of Program Integrity; and Publications and Creative Services.

Background Checks and Requirements

If selected as a finalist, we will conduct a criminal history and background check. Adverse criminal history or background check may lead to disqualification. Additional background check information.

The Oregon Department of Human Services does not offer visa sponsorship. Within three days of hire, you will be required to complete the US Department of Homeland Security's I-9 form confirming authorization to work in the United States. ODHS will use E-Verify to confirm that you are authorized to work in the United States.

Benefits

ODHS Employee Resource Group communities that promote shared learning.

Cost of Living Adjustments.

Annual salary increases (until you reach the top of the listed salary range).

Amazing benefits package.

Possible eligibility for the Public Service Loan Forgiveness Program.

Employment Preference

Veterans' preference.

How to submit your Veteran documents for preference. Please do not attach your Veterans' preference documentation in the Resume / CV field of your application.

General Information

This is a permanent, full-time position and is represented by the Service Employees International Union (SEIU).

This recruitment may be used to fill future vacancies in the same classification.

Contact Information

The recruiter for this position is Nora Leyva Esquivel. If you contact the recruiter, please include the job requisition number : REQ-189730.

Email : Nora.L.LEYVA-ESQUIVEL@odhs.oregon.gov

Phone (call or text) : 503-269-4222