[Hiring] Health Insurance Analyst @State of Oregon

Role Description

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 You will also help clear outdated exemptions so clients can enroll in the right Managed Care plans.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

• 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.

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.

Requirements

• 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.

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.