Director of Claims and Enrollment Operations

3 weeks ago


Corvallis, United States Samaritan Health Services Full time
  • Samaritan Health Plans (SHP) provides health insurance options to Samaritan employees, community employers, and Medicare and Medicaid members. SHP operates a portfolio of health plan products under several different legal structures: InterCommunityHealth Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services' self-funded employee health benefit plan.

    As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services' mission of Building Healthier Communities Together.
  • We are open to remote out of state work in any of our approved states: Alabama, Alaska, Arizona, Arkansas, Connecticut, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, or Wisconsin
  • JOB SUMMARY/PURPOSE
    • Oversees and manages the strategic operations of the Claims, Enrollment, and Provider Data Management departments. Ensures the accuracy, efficiency, and compliance of all related processes, driving improvements and innovations to support organizational goals. Works closely with internal and external stakeholders to ensure service excellence, operational efficiency, and regulatory compliance.
  • EXPERIENCE/EDUCATION/QUALIFICATIONS
    • Bachelor's degree in Healthcare Administration, Business Administration, or a related field; or equivalent experience required. Master's degree preferred.
    • Five (5) years of experience in claims processing, enrollment, and provider data management within a managed care organization or a similar healthcare setting required.
    • Three (3) years leadership experience required.
    • Experience with healthcare regulations, including Medicare and Medicaid, required.
    • Experience in healthcare management systems and data analytics tools required.
  • KNOWLEDGE/SKILLS/ABILITIES
    • Leadership - Inspires, motivates, and guides others toward accomplishing goals. Achieves desired results through effective people management.
    • Conflict resolution - Influences others to build consensus and gain cooperation. Proactively resolves conflicts in a positive and constructive manner.
    • Critical thinking - Identifies complex problems. Involves key parties, gathers pertinent data and considers various options in decision making process. Develops, evaluates and implements effective solutions.
    • Communication and team building - Leads effectively with excellent verbal and written communication. Delegates and initiates/manages cross-functional teams and multi-disciplinary projects.
  • PHYSICAL DEMANDS
    • Rarely
      (1 - 10% of the time)

      Occasionally
      (11 - 33% of the time)

      Frequently
      (34 - 66% of the time)

      Continually
      (67 - 100% of the time)

      LIFT (Floor to Waist: 0"-36") 0-20 Lbs

      LIFT (Knee to chest: 24"-54") 0 - 20 Lbs

      LIFT (Waist to Eye: up to 54") 0 - 20 Lbs

      CARRY 1-handed, 0 - 20 pounds

      CARRY 2-handed, 0 - 20 pounds

      KNEEL (on knees)

      BEND FORWARD at waist

      CLIMB - STAIRS

      STAND

      WALK - LEVEL SURFACE

      ROTATE TRUNK Standing

      REACH - Upward

      PUSH (0-20 pounds force)

      PULL (0-20 pounds force)

      SIT

      ROTATE TRUNK Sitting

      REACH - Forward

      MANUAL DEXTERITY Hands/wrists

      FINGER DEXTERITY

      PINCH Fingers

      GRASP Hand/Fist

      None specified


  • Corvallis, Oregon, United States HexaQuEST Health, Inc. Full time

    About HexaQuEST Health, Inc.HexaQuEST Health, Inc. is a leading provider of health plans and services in the region. Our company mission is to build healthier communities together.Job SummaryWe are seeking an experienced Senior Claims Operations Director to oversee and manage our Claims Department in Corvallis. The ideal candidate will have strong management...


  • Corvallis, United States HexaQuEST Health, Inc. Full time

    Job Description: Hybrid position, will be onsite in Corvallis 2-3 times a week or more if needed. We need a candidate with strong management experience. JOB SUMMARY/PURPOSE Oversees and manages the Samaritan Health Plans Claims Department. Is responsible for accurate and timely claims processing for all programs administered by Samaritan Health Plans....


  • Corvallis, United States Oregon State University Foundation Full time

    Description Reporting to the Senior Director of Data Operations and CRM Strategy, the Director, Data Operations serves as the key leader for the data operations team and is responsible for overseeing, implementing, and developing key data acquisition, protocol development and concierge services that support our data ecosystem that enable the Foundation's...


  • Corvallis, Oregon, United States Health Care Specialists of America Full time

    The opportunity to lead a multi-specialty practice as a Medical Director in Corvallis, Oregon, is now available. This is a full-time position that requires a board-certified or board-eligible Internal Medicine Physician.About the PracticeOur privately owned practice is well-established and thriving, with a strong focus on providing high-quality patient care....


  • Corvallis, OR, United States Board of Certified Safety Professionals Full time

    The Environmental Health and Safety Department is seeking an Executive Director, Environmental Health and Safety. This is a full-time (1.00 FTE), 12-month, professional faculty position. Reporting directly to the Senior Associate Vice President for Administration (SAVPA), the Executive Director, Environmental Health & Safety effectively provides leadership,...


  • Corvallis, United States HexaQuEST Global - Healthcare Full time

    Job Description:JOB SUMMARY/PURPOSEResponsible for initial receipt, bundling and/or tracking of incoming and outgoing mail for the Samaritan Health Plans facility. Performs claims batching and scanning of paper claims into the EDI conversion system.DEPARTMENT DESCRIPTIONSamaritan Health Plans (SHP) operates a portfolio of health plan products under several...


  • Corvallis, United States Abacus Service Corporation Full time

    Job Type: Contract Job Name: OR - Mail Tech - Days Job Description: JOB SUMMARY/PURPOSE Responsible for initial receipt, bundling and/or tracking of incoming and outgoing mail for the Samaritan Health Plans facility. Performs claims batching and scanning of paper claims into the EDI conversion system. ...

  • Intern

    3 weeks ago


    Corvallis, United States City of Corvallis Full time

    Position Summary Perform a series of work tasks or assignments to assist Parks & Recreation work groups in the research and development of programs and/or the implementation of projects, activities, and programs. Areas of concentration may include: performing arts &...


  • Corvallis, Oregon, United States CodeForce Full time

    At CodeForce, we're dedicated to providing a supportive and dynamic work environment for our nursing team. As a Perioperative Registered Nurse, you'll have the opportunity to work flexible schedules and contribute to the care of patients in a Surgery Center setting.Job Summary: The ASC Staff Nurse: Pre-Op, Post-Op performs nursing functions according to the...

  • Pre-Post Op RN

    4 weeks ago


    Corvallis, United States CodeForce Full time

    Opportunities for flexible schedules and days M-F; shifts range from 4hrs to 10 hoursTraining for RNs with at least 3 years of experience from any clinic or hospital setting looking to expand professional experience and work in a Surgery Center.Relocation reimbursement for qualifying applicants with 2 year commitmentCompensation: $36.75 - $55.15 (depending...

  • Stylist Apprentice

    2 weeks ago


    Corvallis, Oregon, United States Supercuts Full time

    Job SummaryA Stylist in Training position at Supercuts is a temporary 90-day opportunity for an unlicensed individual to gain salon experience and develop skills. This role is designed to integrate the trainee into the salon environment, promoting learning and growth.Key ResponsibilitiesDeliver exceptional customer serviceCommunicate effectively with...


  • Corvallis, OR, United States Samaritan Health Services Full time

    Relocation Allowance (up to): $10,000 Company: Samaritan Health Services Req #: 71300 Location: Corvallis, OR Schedule: 1.0 (80 hrs/pp) - Day Department: SHS Regional Business Office Remote Status: No Salary Range: $51.79 - $77.68 JOB SUMMARY/PURPOSE Responsible for the daily organization and management of system-wide hospital and professional...

  • Food Service Worker

    1 month ago


    Corvallis, Oregon, United States Oregon State University Full time

    Position SummaryThis recruitment will be used to fill part-time student Food Service positions for Oregon State University's University Housing and Dining Services. The positions will be working in one of three dining centers or catering. Dining Position:Must provide exceptional customer service.Assist customers and answer questions regarding menu items,...


  • Corvallis, Oregon, United States Institute of Inspection , Cleaning and Restoration Certification Full time

    Job Position Description:This role is responsible for maintaining clean and healthy floor environments for facilities. As a floor maintenance technician, you will be working with various types of flooring, including carpets, VCT, hardwood, tile, and concrete.Key Responsibilities:Perform thorough cleaning and maintenance duties for facilities using...


  • Corvallis, Oregon, United States Oregon State University Full time

    The Little Beavs Early Learning Center at the Family Resource Center on the Oregon State University Bend campus seeks a Student Early Care and Education Aide to support the center operations. The successful candidate will assist full-time teachers, the Center Director, and other duties, including preparing snacks and lunches for children.Key...


  • Corvallis, United States Samaritan Health Services Full time

    Starting bonus and/or relocation available to new employees. Previous experience may be required. Employment commitment to Samaritan is required. The pharmacy team at Samaritan Health Services is looking for a Traveling Pharmacy Technician to assist pharmacists in medication preparation and labeling activities. Other duties include performing a broad range...


  • Corvallis, United States Samaritan Health Services Full time

    *Starting bonus and/or relocation available to new employees. Previous experience may be required. Employment commitment to Samaritan is required. The pharmacy team at Samaritan Health Services is looking for a Traveling Pharmacy Technician to assist pharmacists in medication preparation and labeling...

  • Maintenance Worker

    3 weeks ago


    Corvallis, United States City of Corvallis Full time

    Position Summary Provide sanitation services for park facilities and routine park maintenance for a designated park route. Operate specialized Parks and Recreation maintenance equipment. Assist with minor repair and maintenance of the City parks grounds and facilities. ...

  • System Specialist

    3 weeks ago


    Corvallis, United States City of Corvallis Full time

    Position Summary Perform duties in alignment with requirements set forth by the Oregon Health Authority to maintain water quality and ensure the integrity of the City‘s water distribution system. Responsibilities include maintaining system operability, providing adequate...


  • Corvallis, United States Samaritan Health Services Full time

    Samaritan Health Plans (SHP) provides health insurance options to Samaritan employees, community employers, and Medicare and Medicaid members. SHP operates a portfolio of health plan products under several different legal structures: InterCommunityHealth Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid...