Senior Claims Specialist, Commercial *Remote*

Providence Health Plan caregivers are not simply valued – they’re invaluable. Join our team and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them. 

Providence Health Plan is calling a Senior Claims Specialist, Commercial who will:

• Serve as a member of a claims team whose purpose is to process claims for Providence Health Plans' customers with superior claims service to support Health Plans operations
• Be responsible for processing claims for members, providers, and employers
• Be responsible for communications with existing and potential members, providers, and employers
• Provide and interpret detailed benefit, eligibility, and premium information on a broad portfolio of products
• Respond to claim inquires
• Resolve member issues or concerns
• Analyze and adjudicate claims to reflect financial, check, and processing accuracy
• Initiate and facilitate member, provider, and employer phone calls to the Providence provider entities, pharmacy department, employer groups, sales and producers in an efficient manner for claims resolution
• Possess the collaborative skills necessary to perform well in a team environment
• Have an advanced skill set in pend / error types
• Have an advanced skill set in file reviews, complex claims adjustments, reporting/projects
• Assist in auditing, mentoring, training claims processors with questions to coordinate training needs, and answering team questions as a back up to the Technical Specialist

Please note the following important detail regarding this role: 

• This position is affiliated with Providence Health Plan and will be tied to a location and compensation range in Beaverton, Oregon

Providence Health Plan welcomes 100% remote work for applicants who reside in one of the following areas: 

• Oregon
• Washington: Clark County

Required qualifications for this position include:

•  1+ years of experience as a Claims Specialist

Preferred qualifications for this position include:

•  Bachelor's Degree and 1+ years of experience in healthcare customer service, claims or accounting

Why Join Providence Health Plan?

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security.  We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.

At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Check out our benefits page for more information about our Benefits and Rewards.