Contracting Specialist Benefits and Claims

Umpqua Health

Job Location:

Roseburg, OR - USA

Yearly Salary: USD 84000 - 95900

Posted on: 11 hours ago

Vacancies: 1 Vacancy

Job Summary

CONTRACTING SPECIALIST BENEFITS AND CLAIMS

HYBRID must be able to travel to 3031 NE STEPHENS ST. ROSEBURG OR 97470

EMPLOYMENT TYPE: Full-Time Exempt

About Umpqua Health

At Umpqua Health were more than a healthcare organizationwere a community-driven Coordinated Care Organization (CCO) dedicated to improving the health and well-being of individuals and families throughout Douglas County Oregon. We provide integrated whole-person care through primary care specialty care behavioral health services and care coordination. Our collaborative approach ensures members receive high-quality personalized care while supporting a stronger healthier community.

POSITION PURPOSE
The Benefit and Claims Oversight Specialist is responsible for ensuring accurate timely and compliant administration of health plan benefits and claims through Umpqua Healths Third-Party Administrator (TPA). This role does not supervise internal staff but holds full oversight responsibility for TPA performance compliance and adherence to contractual and regulatory requirements. The position also manages provider contract distribution benefit administration communications and interpretation of contract requirements. Acting as the primary liaison between Umpqua Health and the TPA this role drives accountability resolves claims issues and supports organizational goals for quality and efficiency.

ESSENTIAL JOB RESPONSIBILITIES
TPA Oversight & Compliance

Oversee Third-Party Administrator (TPA) performance ensuring accuracy timeliness and adherence to service-level agreements.
Lead audits and compliance reviews to ensure alignment with federal and state regulations contractual obligations and organizational standards.
Manage and resolve escalated claims and benefit issues ensuring timely and effective outcomes.

Provider Contract & Benefit Administration

Oversee distribution tracking and validation of provider contracts to ensure accuracy and compliance.
Interpret and operationalize Oregon Health Authority (OHA) and Umpqua Health Network (UHN) contractual requirements.
Ensure accurate configuration and maintenance of benefits fee schedules and authorization rules within claims systems.
Direct data integrity efforts across TPA and internal systems ensuring consistent application of business rules.

Claims Oversight & Issue Resolution

Provide leadership in the resolution of complex claims issues disputes and exceptions.
Ensure accurate interpretation and application of benefit structures by the TPA.
Serve as a key escalation point for internal teams and external partners.

Process Improvement & Policy Management

Develop and implement policies and procedures to strengthen claims oversight and benefit administration.
Identify operational gaps and lead process improvement initiatives to enhance efficiency accuracy and compliance.

Reporting & Stakeholder Communication

Serve as the primary liaison for TPA-related performance and escalation matters.
Deliver regular reporting insights and strategic recommendations to leadership.
Perform other duties as assigned.

CHALLENGES

Working with a variety of personalities maintaining a consistent and fair communication styles.
Satisfying the needs of a fast-paced and challenging company.

MINIMUM QUALIFICATIONS

Bachelors degree in healthcare administration Business or a related field required
Minimum of 5 years of experience in health plan claims processing and benefit administration preferably with TPA oversight responsibilities
Strong understanding of managed care operations and regulatory compliance
Proficiency in claims systems and Microsoft Office Suite
Strong analytical and problem-solving skills
Excellent verbal and written communication skills including negotiation abilities
Ability to manage vendor relationships and enforce accountability
Ability to analyze and interpret data to determine appropriate configuration changes
Ability to accurately interpret state and/or federal benefits contracts and additional business requirements and translate them into configuration parameters
Ability to coordinate and facilitate coding updates related to benefit plans provider contracts fee schedules and system tables through the user interface
Ability to apply previous experience and knowledge to research and resolve claim and encounter issues including pended claims and communicate system update needs to TPAs
Ability to manage fluctuating workloads and prioritize tasks to meet deadlines and the needs of the user community
Demonstrated accountability integrity innovation and collaboration in a professional setting

PREFERRED QUALIFICATIONS

Certified Coder (preferred)
Bilingual translation or translation capabilities a plus

SCHEDULE
Monday through Friday - 8:00am - 5:00pm; standard business hours with flexibility to meet service timelines.

SALARY
Wage Band: $

BENEFITS

Salary is dependent on skills experience and education
Generous benefits package including vacation PTO sick leave federal holidays and birthday leave
Medical dental and vision insurance
401(k) with company match (fully vested immediately)
Company-sponsored life insurance and additional benefits
Fitness reimbursement program
Tuition reimbursement and more

Why Umpqua Health

We are committed to advancing health equity by collaborating across communities addressing systemic barriers and ensuring fair access to care and resources. At Umpqua Health every team member plays a vital role in making a meaningful impact empowering healthier lives and strengthening the communities we serve.

Inclusive Culture
We foster a respectful inclusive environment where employees feel valued supported and empowered.
Growth & Development
We support ongoing learning through mentorship clear career pathways and professional development opportunities.
Work/Life Balance
We promote flexibility and well-being so employees can thrive both professionally and personally.

Equal Opportunity

Umpqua Health is an equal opportunity employer that embraces individuals from all backgrounds. We prohibit discrimination and harassment of any kind ensuring that all employment decisions are based on qualifications merit and the needs of the business. Our dedication to fairness and equality extends to all aspects of employment including hiring training promotion and compensation without regard to race color religion gender gender identity or expression sexual orientation national origin genetics disability age veteran status or any other protected category under federal state or local law.

Required Experience:

Manager

CONTRACTING SPECIALIST BENEFITS AND CLAIMSHYBRID must be able to travel to 3031 NE STEPHENS ST. ROSEBURG OR 97470EMPLOYMENT TYPE: Full-Time ExemptAbout Umpqua HealthAt Umpqua Health were more than a healthcare organizationwere a community-driven Coordinated Care Organization (CCO...