Health Insurance Analyst, Administrative Specialist 1

State of Oregon · Salem · $3,798–$5,193/month (stated in the posting)

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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.

Bring Your Expertise and Talent and Join Us as a Health Insurance Analyst!

The Oregon Department of Human Services is looking for a motivated, detail‑driven professional to join our Health Insurance Group within the Office of Payment Accuracy and Recovery. As a Health Insurance Analyst (Administrative Specialist 1), you will help make a real difference for Oregon’s Medicaid clients.

In this role, you will ensure third‑party insurance information is entered accurately and on time, helping prevent unnecessary Medicaid costs, supporting recovery of incorrect payments, and ensuring clients receive the benefits they deserve. You will also help clear outdated exemptions so clients can enroll in the right Managed Care plans.

If you enjoy meaningful work, problem‑solving, and being part of a supportive team that values accuracy and service, we want you on our team!

Summary of Duties

As a Health Insurance Analyst, you will:

Coordination

• Contribute to continuous process improvement by participating in Lean‑focused teams and committees.
• Coordinate daily workflow and support team operations.
• Complete assignments from leadership in a timely manner.
• Review updated policies and procedural materials as required.
• Maintain an organized workstation and effective workload management.

Administrative Assignments

• Independently review, analyze, and research Third Party Resource referrals to determine completeness and eligibility for entry into the Medicaid Management Information System.
• Verify current and past Medicaid coverage using system eligibility screens.
• Assess whether referrals contain new information, duplicate existing records, or require additional research.
• Research historical information in available state systems when referral details are incomplete and return unverified referrals to the source when necessary.
• Identify Child Protective Services and Domestic Violence cases and determine appropriate actions to protect confidentiality and safety.
• Process referrals from multiple work queues, including phone calls, inbox submissions, webforms, internal reports, and other designated sources.
• Contact insurance carriers to request and verify policy information and provide clear explanations of applicable laws, rules, and confidentiality requirements.
• Gather and assess insurance information from carrier websites to determine accuracy and completeness.
• Enter, update, and maintain Third Party Resource records in the Medicaid Management Information System and ensure accuracy of all changes.
• End special Medicaid exemption conditions when appropriate to support enrollment into a Coordinated Care Organization.
• Notify referral sources of actions taken when required.
• All staff log into the call system and rotate answering calls throughout their shift. Inbox referrals are assigned on a daily rotation based on business needs.

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

We are looking for candidates with:

• Experience coordinating and understanding health insurance benefits.
• Experience navigating and operating medical billing systems and related computer‑based tools.
• Experience in accurately researching, entering, updating, and retrieving alphanumeric data with consistent efficiency
• Proficient in communicating effectively with individuals via telephone, written correspondence, and in-person interactions.
• Experience showing exceptional attention to detail when reviewing, verifying, and processing information. 

Attention all candidates! A cover letter describing how you meet each of the essential attributes and minimum qualifications listed is required as part of the application.This information will be used as screening criteria to determine whether an invitation to interview will be extended.  Failure to submit the required cover letter will result in disqualification of your application.

• Please upload a resume or complete the work history profile. Note: Your resume and cover letter may be uploaded in the Resume/CV field on the online application.
• 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.
• The job posting closes at 11:59 PM (PDT/PST) on the close date. Immediately after you submit your application, be sure to respond to the two questionnaires relating to public records requests and veterans’ preference. These questions are necessary to complete the application process.

Working Conditions

•  Work is performed remotely, 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.
• You may be required to come into the office in Salem quarterly for meetings, training, business or operational needs.
• The working hours for this position are 8:00am to 5:00pm, Pacific Standard Time.

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’ and Oregon National Guard preference:

• Eligible Veterans and Oregon National Guard servicemembers (current and former) who meet the qualifications of the position will be awarded candidate preference. For more information, please visit Veterans Resources. 

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

We invite you to contact the recruiter for accommodation requests under the Americans with Disabilities Act (ADA), application questions or job-specific questions.

• The recruiter for this position is Nora Leyva Esquivel. If you contact the recruiter, please include the job requisition number: REQ-208678.
• Email: Nora.L.LEYVA-ESQUIVEL@odhs.oregon.gov
• Phone (call or text): 503-269-4222

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