Marketplace Enrollment and Appeals Specialist – Limited Duration

Oregon Department of Human Services

Marketplace Enrollment and Appeals Specialist at Oregon Health Authority analyzing complex insurance cases. Evaluating program operations and developing guidelines for state agencies and community organizations.

Posted 6/29/2026full-timeSalem • Oregon • 🇺🇸 United StatesJuniorMid-Level💰 $5,458 - $8,352 per monthWebsite

About the role

Key responsibilities & impact

Serve as a Medicaid and Marketplace insurance subject matter expert, applying comprehensive insurance knowledge to analyze complex cases involving eligibility, enrollment, identity verification, technology platform issues, escalations, complaints, and appeals.
Evaluate program operations for the state-run technology platform and consumer assistance center (CAC).
Develop operational guidelines and procedures for use by state agencies, insurance carriers, health insurance agents, and community-based organizations.
Support training and development, compliance, and quality assurance activities for both the technology platform and the CAC.

Requirements

What you’ll need

A Bachelor's Degree in Business or Public Administration, Behavioral or Social Sciences, or a degree related to the agency program that demonstrates the capacity for the knowledge and skills; and two years experience coordinating or administering a program.
Any combination of experience or education equivalent to five years of experience that typically supports the knowledge and skill requirements listed for the classification.
Knowledge of Medicaid, Medicare, Oregon Division of Financial Regulation programs, and Oregon Health Insurance Marketplace products, policies, and health insurance coverage types.
Demonstrated experience in healthcare customer service and insurance operations, including resolving complex eligibility, enrollment, identity verification, and case issues.
Demonstrated experience analyzing complex cases, interpreting program rules, and developing appropriate solutions within established guidelines.
Strong background in health insurance laws and regulations and their application to casework, appeals, escalations, and compliance-related decisions.
Ability to exercise sound judgment, impartiality, tact, and diplomacy in high-stress, sensitive, or controversial situations.
Ability to communicate effectively in writing and verbally with diverse populations, including explaining complex information clearly and accurately.
Skill in using automated systems, data tracking tools, and standard office software (e.g., spreadsheets, word processing) to manage, analyze, and document information.
Demonstrated experience supporting or contributing to operational procedures, training, compliance, or quality assurance activities in a program or service environment.

Benefits

Comp & perks

Excellent, low-cost medical, vision, and dental coverage for you and your family.
Optional benefits like life insurance, disability coverage, deferred compensation, and FSA options for health and childcare.
Generous paid time off: 11 holidays, 3 personal days, monthly sick leave, and vacation accrual starting at 8 hours/month.
Potential eligibility for the Public Service Loan Forgiveness Program.
Retirement security through Public Employees Retirement System (PERS)/ Oregon Public Service Retirement Plan (OPSRP).
Training and development opportunities to grow your career with the State of Oregon.

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Case AnalysisEligibility VerificationEnrollment ProcessesIdentity VerificationHealth Insurance LawsProgram Rule InterpretationSolution DevelopmentData AnalysisOperational Guidelines DevelopmentTraining Support

Soft Skills

Effective CommunicationSound JudgmentImpartialityTactDiplomacy