Jobs at CareOregon

Translate English member materials into culturally appropriate Spanish using CAT tools, ensure accuracy, style, and reading-level compliance, proofread vendor work, collaborate with creative teams, and meet deadlines to support language access for LEP members.

Serve as primary liaison between CareOregon and provider partners to onboard, educate, and support contracted providers. Conduct orientations, site visits, trainings, complaint resolution, contract support, and cross-department collaboration to identify network needs and ensure regulatory and contractual compliance.

Adjudicate and investigate medical, dental, and mental health claims for Medicaid/Medicare and commercial plans. Re-adjudicate/adjust claims, determine eligibility and coordination of benefits, investigate third-party issues, generate correspondence, report payment irregularities, and meet quality and productivity standards while collaborating with internal teams and maintaining up-to-date knowledge of policies and regulations.

Lead large, complex, enterprise-wide technology and operational projects using project management and Lean principles. Scope, plan, implement, monitor status, manage stakeholders, ensure compliance, track costs, drive change management, document outcomes, and recommend process improvements across cross-functional teams.

Adjudicate Medicaid, Medicare, group and individual medical, dental, and mental health claims; re-adjudicate and adjust claims; ensure compliance with regulations and plan provisions; meet quality and productivity standards; investigate third-party issues; generate correspondence; collaborate with teams and continuously update knowledge of processes and policies.

Lead large-scale projects, programs, and process improvements using project/program management, change management, and Lean principles. Develop plans, manage stakeholders and resources, monitor status, budgets and compliance, deliver training, mentor staff, and ensure successful implementation and documentation across health plan systems.

Lead enterprise provider data management and credentialing operations for Medicaid and Medicare lines, ensuring compliant, accurate provider data, optimized systems, strategic network development, resource and budget management, process improvement, and team leadership to meet regulatory and organizational objectives.

Senior finance partner providing FP&A and enterprise-level financial insight to regional and executive leaders. Translates financial, operational, clinical, and market data into executive- and Board-ready narratives, leads budgets, rolling forecasts, scenario and stress-testing, drives performance initiatives, and coaches analysts and junior finance partners to support strategic decision-making.

Conduct and document fraud, waste, and abuse (FWA) investigations and audits; prepare reports and corrective action recommendations; maintain FWA documentation and reporting; support policy, training, risk assessment, and regulatory requests; analyze and present data to internal and external stakeholders.

Lead and perform advanced fraud, waste, and abuse (FWA) investigations for Medicare/Medicaid lines, develop and maintain FWA programs, produce reports and dashboards, coach staff, and support regulatory filings and corrective actions.

Senior-level accountant responsible for general ledger maintenance, complex journal entries, reconciliations, and advanced data analysis. Prepares monthly and external regulatory financial reports, annual tax filings, supports audits, develops reports using Excel and reporting/GL software, collaborates with internal teams and regulators, and mentors finance staff.

Lead large, complex enterprise projects across the full lifecycle using project management and Lean principles. Scope, plan, manage, implement, and report progress; facilitate stakeholder collaboration and change management; track costs and ensure compliance; support technical implementations and process improvements.

Lead and expand a customer-centered finance organization overseeing accounting, financial reporting, FP&A, actuarial analysis, rate development, risk adjustment, and procurement. Provide strategic financial leadership for Medicaid/Medicare populations, guide budgeting/forecasting, advise executive leadership, manage stakeholder relationships, and build high-performing teams while ensuring compliance and regulatory reporting.

Perform intermediate-to-advanced analysis and visualization of healthcare quality metrics using SQL, Snowflake, Databricks, and Tableau. Develop dashboards, forecast performance, and provide data-driven insights to leaders. Act as SME on clinical quality measures, support regulatory deliverables, collaborate with internal and external stakeholders, and create documentation and metric monitoring systems to support quality improvement initiatives.

Perform QA reviews of HRSN/rent-assistance benefit allocations, validate documentation and calculations, analyze trends, prepare reports for leadership and OHA, support audits and corrective actions, provide data entry and accounting support, maintain records, and develop training and process improvements. Use Office, SharePoint, Workday, and Unite Us; collaborate with cross-functional teams to ensure compliance and program quality.