PacificSource Health Plans

Role Description The Member Support Specialist will work as an integral part of the case management team to serve as a resource to members. The Specialist will work telephonically and in person to support members with complex psycho-social issues which create barriers to adherence with medical regimens and achievement of optimal health outcomes. Examples may include activities such as assisting with arranging transportation, linking patients with community resources, etc. Will assist with program development, and build effective member and provider relationships. - In coordination with the member’s case manager, develop and implement goals and/or plans tailored to assist members in navigating the complexities of the healthcare system. - Educate members on understanding and working within the parameters of their benefit structure. - Utilize motivational interviewing and patient-engagement techniques to support members in achieving optimal health outcomes by effectively utilizing their benefits. - Identify community resources and make referrals to members as appropriate. - Serve as liaison between members and providers/agencies. - Identify members for coordination and case management services through a variety of methods, including claims data and reports. - Screen requests to identify appropriate referrals to case management from multiple internal and external sources. - Work collaboratively with the case management team to help facilitate case management process. Participate in case management/care coordination meetings. - Ensure compliance with applicable state and federal regulations and guidelines in day-to-day activities, including maintaining HIPAA standards and confidentiality of protected health information. Ensure accurate and timely documentation. - Assist members with referrals, scheduling appointments and ensuring transportation to medical appointments is available. - Assist members with non-clinical needs for transitions and different phases of care. - Manage mailing lists and outgoing mailings. Supporting Responsibilities - Assist with the development of departmental procedures, reports and projects. - Assist care management to meet quality measures as outlined by government regulations. - Enter and collate data: prepare reports as assigned. - Participate in team, department, company, and community-related committees as requested. - Make presentations to small groups. Actively participates in quality improvement initiatives. - Meet department and company performance and attendance expectations. - Perform other duties as assigned. Work Experience - A minimum of three years of experience in community services or healthcare agencies focused on coordination services required. - Experience in health insurance and delivering group presentations preferred. Education, Certificates, Licenses - High school diploma or equivalent required. Knowledge - Medical terminology. - Proficient in Microsoft Office, including Word, Excel, PowerPoint, Medical management software (e.g CaseTrakker Dynamo). - Excellent verbal and written communication skills and is able to work independently as well as to work effectively on a team. - Good working knowledge of how to access community resources and healthcare system. Competencies - Building Customer Loyalty - Building Strategic Work Relationships - Contributing to Team Success - Planning and Organizing - Continuous Improvement - Adaptability - Building Trust - Work Standards Environment - Work inside in a general office setting with ergonomically configured equipment. - Travel is required approximately 20% of the time. Skills - Accountability - Collaboration - Communication (written/verbal) - Flexibility - Listening (active) - Organizational skills/Planning and Organization - Problem Solving - Teamwork Compensation Disclaimer The wage range provided reflects the full range for this position. The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range. Base Range: $35,542.81 - $56,868.50 Our Values - We are committed to doing the right thing. - We are one team working toward a common goal. - We are each responsible for customer service. - We practice open communication at all levels of the company to foster individual, team and company growth. - We actively participate in efforts to improve our many communities-internally and externally. - We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community. - We encourage creativity, innovation, and the pursuit of excellence. Physical Requirements - Stoop and bend. - Sit and/or stand for extended periods of time while performing core job functions. - Repetitive motions to include typing, sorting and filing. - Light lifting and carrying of files and business materials. - Ability to read and comprehend both written and spoken English. - Communicate clearly and effectively. Disclaimer This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

Role Description The Director of Claims and Encounters Operations is responsible for leading the day-to-day operations of claims processing and encounter submissions. This role partners with senior leadership to execute strategic priorities, ensure regulatory compliance, meet service level expectations, and drive operational efficiency across all lines of business, including Commercial, Medicare Advantage, and Medicaid. The Director oversees managers and frontline leaders, ensuring performance against contractual and regulatory requirements while continuously improving workflows, productivity, quality, and the overall customer experience. - Lead and manage daily operations for claims processing and encounter submissions across all lines of business. - Execute operational plans that align with organizational strategy, regulatory requirements, and performance expectations. - Ensure consistent achievement of government contractual Service Level Agreements (SLAs) and Commercial Performance Guarantees. - Monitor key performance metrics including productivity, quality, turnaround time, and inventory and implement corrective actions based on trends. - Partner with leadership on capacity planning, staffing models, and workload forecasting. - Design, implement, and refine scalable workflows for claims adjudication and encounter submission. - Identify and implement opportunities to reduce errors, improve first pass resolution rates, and increase operational efficiency. - Collaborate with Payment Integrity and vendor partners to ensure proper claim adjustments and financial accuracy. - Work with IT, Configuration, Compliance, Finance, and Product teams to define business requirements and support system enhancements for claims and encounters processing. - Ensure compliance with CMS, state, and federal regulations, including Medicare Advantage and Medicaid requirements. - Maintain readiness for audits, reviews, and regulatory reporting. - Oversee the development, maintenance, and adherence to policies, procedures, and internal controls related to claims and encounters. - Support continuous improvement initiatives focused on reducing Average Handle Time (AHT), rework, and operational backlog. - Lead, coach, and develop managers and staff through performance management, training, and succession planning. - Manage claims-related vendor relationships to ensure service quality and return on investment. - Participate in cross-functional forums to support enterprise initiatives and operational alignment. Qualifications - Minimum of 8 years of healthcare operations experience, with a strong focus on claims processing and/or encounters. - Minimum of 3 years of progressive leadership experience managing teams or managers in a healthcare operations environment. - Demonstrated experience in operational improvement, workflow design, and performance management. - Experience working with Medicaid, Medicare Advantage, and Commercial lines of business strongly preferred. - Experience supporting or operating within a cost containment program preferred. Requirements - Bachelor’s degree required. Preferred areas of focus: business, finance, healthcare administration, or a related field. - Candidates with an associate’s degree and 2 years of relevant experience, or a high school diploma and 4 years of relevant experience, in addition to the required minimum years of work experience will also be considered. Benefits - Accountable leadership. - Business & financial acumen. - Empowerment. - Influential Communications. - Situational Leadership. - Strategic Planning. Environment - Work inside in a general office setting with ergonomically configured equipment. - Travel is required approximately 10% of the time. Physical Requirements - Stoop and bend. - Sit and/or stand for extended periods of time while performing core job functions. - Repetitive motions to include typing, sorting, and filing. - Light lifting and carrying of files and business materials. - Ability to read and comprehend both written and spoken English. - Communicate clearly and effectively.

Role Description The Risk Adjustment Coding Auditor reviews medical records to ensure accurate, compliant ICD 10 CM coding across Medicare Advantage, ACA/Commercial, and Medicaid programs. This role validates coding accuracy and specificity, audits external coding vendors, and provides feedback to improve documentation and coding performance. The auditor also leads ACA and Medicare Advantage RADV activities, ensuring timely retrieval, review, and submission of records in line with federal and state requirements. - Conduct retrospective and prospective medical record audits to ensure ICD 10 CM diagnosis codes are accurate, complete, specific, and supported by documentation. - Ensure all coding practices comply with CMS risk adjustment guidelines, ICD 10 CM Official Coding Guidelines, and AAPC/AHIMA standards. - Identify coding trends, documentation gaps, errors, and opportunities to improve risk score accuracy. - Validate clinical evidence supporting chronic condition coding to ensure proper documentation and submission. - Prepare detailed audit reports summarizing findings, error categories, trends, and recommendations for corrective action. - Provide clear, constructive feedback to coding teams, providers, and vendor partners based on audit outcomes. - Develop and deliver training materials, job aids, and educational sessions to address documentation and coding improvement areas. - Serve as a subject matter expert on risk adjustment coding best practices, documentation requirements, and regulatory updates. - Collaborate with internal teams including Risk Adjustment Operations, Coding, Compliance, Quality, and Provider Engagement. - Lead and execute ACA and Medicare Advantage RADV audits, including medical record retrieval, coding review, appeals support, and documentation submission to IVA and CMS portals. - Oversee coding vendors and In Home Assessment programs to ensure performance aligns with contractual SLAs. - Obtain medical records from provider Electronic Health Record (EHR) systems and coordinate remote EHR access for internal teams and chart review vendors. - Maintain audit documentation and support tracking of corrective action plans. - Participate in internal and external audits initiated by regulatory bodies, partners, or compliance teams. - Support the development and refinement of audit methodologies, tools, and internal risk adjustment processes. - Assist in updating organizational policies and procedures to ensure regulatory compliance. - Monitor changes in risk adjustment regulations and coding guidelines and incorporate required updates into internal practices. Qualifications - A minimum of 4 years of risk adjustment coding experience, including hands-on HCC coding, is required. - Proficiency in coding directly from the ICD 10 CM code book is required. - Experience with different EMRs and medical records retrieval outreach activities is required. - Experience conducting coding audits and interpreting complex regulatory guidelines is highly preferred. - Prior experience working within a health insurance plan, health system, or large provider organization is preferred. - Experience developing or delivering coder or provider education is also desirable. Requirements - Bachelor’s degree preferred. - High school diploma or equivalent required. - Active Certified Risk Adjustment Coder (CRC) and Certified Professional Medical Auditor (CPMA) certifications through AAPC are required. Benefits - Compensation range: $72,443.87 - $126,776.77. - Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Environment - Work inside in a general office setting with ergonomically configured equipment. - Travel is required approximately 5% of the time. Physical Requirements - Stoop and bend. - Sit and/or stand for extended periods of time while performing core job functions. - Repetitive motions to include typing, sorting, and filing. - Light lifting and carrying of files and business materials. - Ability to read and comprehend both written and spoken English. - Communicate clearly and effectively. Disclaimer This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

Role Description The Provider Network Access to Care Analyst II is responsible for objectively assessing compliance with State and Federal access to care regulations, standards, and guidance. In addition to managing targeted data streams as applicable, the Analyst II will analyze Enterprise-wide data sets, identify trends, and develop access trend analysis dashboards and reports for internal review and regulatory reporting purposes. The Analyst II is also responsible for writing narrative summaries of trends supported by data visualizations for internal stakeholders and regulatory reports. - Manage targeted data streams with an emphasis on continuous improvement of methodology, deliverables, internal and external customer satisfaction, and data insights. - Develop internal and external customer relationships to support quality and success of data collection and reporting. - Analyze existing and proposed access to care data sets against State and Federal standards to determine compliance. - Develop trends analysis including gaps, opportunities, and data visualizations for internal and external use. - Prepare and present routine reports to internal decision-making audiences including but not limited to Access to Care Steering Committee and other network monitoring groups based on reporting calendar. - Collaborate with Provider Network analysts and cross-departmental committees to hone and present data and findings. - Develop regulatory report narratives related to access data analysis and trends supported by graphs and/or infographics. - Support the development of data dashboards in collaboration with Access team and IT/Analytics. - Understand and leverage data trends to inform and influence decision-making. - Lead continuous improvement initiatives aimed at improving data collection and analysis. - Maintain reporting calendar and ensure reporting deadlines are consistently and accurately met. - Maintain an organized tracking system of all findings, including reports that demonstrate change over time. - Participate in internal workgroups focused on access to care requirements and initiatives. - Participate in external audits as required. Qualifications - Minimum of 4 years of experience in quantitative and qualitative data and/or data trends analysis required. - Experience working with and developing data visualizations and writing narrative summaries of data trends required. - Experience with government reporting and data submissions preferred. - Experience with Microsoft Power BI a plus. - Relevant bachelor’s degree or equivalent combination of related experience and education required. - Data analysis training highly preferred. Requirements - High level of skill identifying gaps and trends in quantitative and qualitative data. - Skills and experience in data visualization, data presentation, and data narrative development. - Strong attention to detail. - Knowledge of medical and insurance industry preferred. - Experience required in Microsoft Excel and Word. - Ability to prioritize work and manage deadlines. - High level of organization skills and self-motivation required. Benefits - Compensation range: $65,296.83 - $111,004.62. - Wage range reflects the full range for this position; actual compensation will be determined based on qualifications, experience, education, and internal equity. Company Description PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.

Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths. Work within a team to design, develop, and maintain backend services that process complex data, including EDI X12 standards, while ensuring the integrity of data exchanges across internal and external systems. Key responsibilities include analyzing requirements, understanding business processes, and developing solutions that support business applications. These solutions often involve integrating functionality across on-premises systems, external applications, business partner networks, and government sources. Collaborate with cross-functional teams, including IT and business stakeholders, to ensure seamless operations and meet customer needs. Manage time and expectations to deliver high-quality solutions that align with business goals and ensure stakeholder satisfaction. Facets/EDI Developer II works within a team to design, develop, and maintain backend services that process complex data, including EDI X12 standards, while ensuring the integrity of data exchanges across internal and external systems. The specific duties include the following: - Develop, optimize, and support code solutions in languages like Python, C#, and Microsoft Transact-SQL to enhance systems managing healthcare EDI X12 transactions and related business logic. [15%] - Design and implement solutions for processing EDI X12 files using Edifecs to parse, transform, validate, and manage EDI data. Ensure that EDI transactions comply with industry specific regulations and company policies regarding data security and privacy (e.g., HIPAA). [25%] - Develop and maintain solutions to manage the end-to-end encounter data submission process through the Edifecs Encounter Management, ensuring data accuracy, compliance, and timely delivery to regulatory entities. [15%] - Design and develop backend services, APIs, and stored procedures to support reliable data extraction, transformation, and updates on TriZetto Facets database, ensuring data integrity and alignment with healthcare business requirements. [20%] - Work with the Facets Core Administration platform to support business logic related to healthcare claims processing, billing, and member data management, ensuring compliance with industry regulations. [15%] - Design and implement comprehensive unit, integration, and system testing strategies to ensure the accuracy and functionality of EDI systems. Conduct code reviews and assist entry level developers with technical design decisions and debugging strategies. [5%] - Diagnose and resolve complex production issues involving multiple systems or services. Complete post-incident reviews and implement preventive measures. [2%] - Identify and implement process improvement within the EDI and Facets environments to increase automation, reduce manual intervention, and improve data accuracy. [2%] - Stay current with new healthcare regulations and technologies related to EDI and Facets to propose enhancements and ensure ongoing compliance. [1%] Requirements: Bachelor’s degree in Computer Science or a related field. In addition, a minimum of two (2) years’ experience which must include at least two (2) years’ experience in each of the following: - Hands-on experience in Healthcare EDI and FACETS development and analysis - Visual Studio.NET languages (primarily C#), object-oriented programming languages (mainly Python), and SQL/Stored Procedures - Edifecs Encounter Management to manage the end-to-end encounter data submission process - Edifecs Smart Trading Platform for handling EDI transaction flows - Edifecs Spec Builder for EDI data mapping and transformation based on regulatory standards (e.g., HIPAA) - Facets Core Administration platform and TriZetto Facets database structures, particularly in member enrollment, claims processing, billing, and payment management in a healthcare setting - REST/SOAP APIs to support and enhance applications - Working with EDI communication protocols like FTP, SFTP, etc. - Working collaboratively within a cross-functional team, contributing to both technical and business goals required Employer: PacificSource; Location: Springfield, OR; Salary: $87,000 per year. 40hrs/wk. Send resume and cover to Melissa.Shinney@pacificsource.com and refer to ID# 2026-501 Skills: Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork Compensation Disclaimer The wage range provided reflects the full range for this position. The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range. Base Range: $64,871.24 - $110,281.11 Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: - We are committed to doing the right thing. - We are one team working toward a common goal. - We are each responsible for customer service. - We practice open communication at all levels of the company to foster individual, team and company growth. - We actively participate in efforts to improve our many communities-internally and externally. - We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community. - We encourage creativity, innovation, and the pursuit of excellence. Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively. Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths. Provide excellent customer service primarily by telephone to all PacificSource customers. Assist customers with coverage/claims related questions. Accurately interpret benefits and policy provisions for all PacificSource products. Conduct appropriate research and follow-up for prompt resolution of disputed claims. Essential Responsibilities: - Work efficiently in a high volume call center while maintaining a professional, positive, and caring demeanor. - Assist callers with coverage related questions/concerns; accurately interpret policy provisions for assigned products. - Analyze customer’s inquiries and determine correct steps for resolution, interpret benefit information, and claims processing accuracy. Keep resource information up to date and well organized. - Work efficiently in multiple systems simultaneously while effectively utilizing critical thinking and problem solving skills. - Document calls in a clear and consistent manner in computer system. - Conduct appropriate research, take ownership and follow through for prompt resolution of disputed claims. - Relay information to appropriate departments and personnel using established communication channels and procedures. - Make outbound calls to members as necessary dependent upon current outreach campaign. Supporting Responsibilities: - Meet department and company performance and attendance expectations. - Be aligned with PacificSource company values. - Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information. - Perform other duties as assigned. SUCCESS PROFILE Work Experience: One-year medical insurance, other healthcare related field, call center or customer service experience required. CPT/ICD-10 coding preferred. Education, Certificates, Licenses: High School Diploma or equivalent required. Knowledge: Basic understanding of insurance and medical terminology, coding and standard medical billing practices preferred. Proficient computer skills, typing, and 10-key required. Strong written and verbal communication skills. Competencies: Building Customer Loyalty Building Strategic Work Relationships Contributing to Team Success Planning and Organizing Continuous Improvement Adaptability Building Trust Work Standards Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately less than 5% of the time. Skills: Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork Compensation Disclaimer The wage range provided reflects the full range for this position. The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range. Base Range: $32,311.65 - $51,698.64 Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: - We are committed to doing the right thing. - We are one team working toward a common goal. - We are each responsible for customer service. - We practice open communication at all levels of the company to foster individual, team and company growth. - We actively participate in efforts to improve our many communities-internally and externally. - We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community. - We encourage creativity, innovation, and the pursuit of excellence. Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively. Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths. Provide overall leadership and direction for multi-channel Contact Center Customer Service teams, ensuring timely and effective responses to customer inquiries. Oversee service performance metrics to meet PacificSource’s standards and support high levels of member and provider satisfaction. Uphold and advance PacificSource’s reputation for exceptional service by actively supporting the organization’s vision, mission, and values. Essential Responsibilities: - Provide direct leadership to team leaders and indirect leadership to all department staff, ensuring consistent achievement of Standards of Work, Service Level Agreements (SLAs), and departmental performance goals. - Ensure team leaders clearly understand and manage expectations related to workflow, quality, productivity, staffing adherence, and individual performance metrics. - Drive accountability for key contact center KPIs, including but not limited to: Service Level / Speed of Answer, Abandonment Rate, First Call Resolution (FCR), Average Handle Time (AHT) (balanced with quality), Call Quality Scores, Schedule Adherence, After‑Call Work (ACW), and Member and Provider Satisfaction. - Build and sustain high‑performing teams through visible leadership, consistent communication, recognition, and engagement practices that support KPI and SLA achievement. - Resolve complex and escalated customer complaints, ensuring outcomes meet service recovery standards, quality expectations, and regulatory requirements. - Oversee audit and quality monitoring programs to ensure call responses consistently meet standards for accuracy, courtesy, compliance, and first‑call resolution. - Ensure corrective actions are implemented promptly when KPI or SLA targets are missed, including performance coaching, workflow adjustments, or process improvements. - Lead the oversight, development, implementation, and communication of departmental programs, policies, and procedures to support operational consistency and performance outcomes. - Manage the full employee lifecycle, including hiring, onboarding, coaching, performance evaluations, corrective action, and terminations, ensuring alignment with service expectations and productivity requirements. - Provide ongoing performance feedback through regular one‑on‑one meetings, scorecard reviews, and formal performance evaluations, using data and metrics to guide development. - Develop and manage the annual department budget; monitor expenses against plan and adjust resource allocation to support volume forecasts, service levels, and organizational priorities. - Partner with key departments (e.g., Operations, IT, Finance, Training, Compliance) to ensure cross‑functional alignment and support SLA commitments. - Lead continuous improvement initiatives using Lean methodologies, focusing on reducing waste, improving efficiency, and enhancing the member experience. - Utilize visual management boards, dashboards, and daily huddles to monitor KPIs, SLAs, trends, and gaps, and to identify and prioritize improvement opportunities. - Actively participate as a key contributor in Manager and Supervisor meetings to review performance results, share best practices, and align strategic initiatives. - Serve on strategic and operational committees to represent contact center needs, communicate performance insights, and reinforce PacificSource values and service expectations across the organization. Supporting Responsibilities: - Meet departmental and organizational performance standards, including productivity, quality, and attendance expectations. - Adhere to PacificSource privacy policies and comply with all HIPAA laws and regulations to ensure the confidentiality and security of protected health information. - Perform additional duties and responsibilities as assigned. SUCCESS PROFILE Work Experience: A minimum of 5 years of progressive customer service experience required, including at least 2 years of customer service operations experience within a contact center or similar high‑volume service environment required. Prior supervisory experience is strongly preferred. Experience leading contact center performance with direct accountability for key performance indicators (KPIs) and Service Level Agreements (SLAs), required. Health insurance industry experience and strong medical terminology knowledge strongly preferred. Experience leading and/or supporting technology innovation initiatives within a customer service or contact center environment preferred. Proven success fostering a collaborative, inclusive, and high‑performance team culture that encourages engagement, innovation, and shared ownership of results required. Education, Certificates, Licenses: Bachelor’s degree required. Preferred areas of focus: business or related field. Candidates with an associate’s degree and 2 years of relevant experience, or a high school diploma and 4 years of relevant experience, in addition to the required minimum years of work experience will also be considered. Knowledge: Demonstrated ability to develop a comprehensive understanding of PacificSource products, plan designs, provider relationships, and health insurance terminology across Commercial and/or Government healthcare lines. Proven strength in building effective working relationships and delivering clear, proactive communication, with the ability to perform well under time‑sensitive conditions and manage workload independently. Strong computer proficiency, including working knowledge of Microsoft Office applications, accurate typing skills, and a foundational understanding of claims processing systems and standard customer service operations. In depth knowledge of contact center technologies, including operational oversight, optimization, and performance management, is highly valued. Demonstrated capability in change management, including fostering a supportive, trauma‑informed culture for both staff and PacificSource Health Plan members. Proven ability to establish, communicate, and enforce Standards of Work (SOW) to ensure consistent service delivery, quality, compliance, and operational efficiency. Strong people‑leadership and management skills, including the ability to coach, mentor, and develop leaders and staff to improve performance, engagement, and retention. Demonstrated effectiveness in providing clear expectations, ongoing feedback, and data‑driven performance management aligned with organizational goals. Ability to lead with integrity and accountability by modeling PacificSource values, reinforcing ethical behavior, and ensuring compliance with regulatory and organizational standards. Strong communication skills with the ability to clearly convey performance expectations, operational priorities, and strategic direction to leaders, teams, and cross‑functional partners. Ability to partner across departments to drive continuous improvement, operational alignment, and service excellence in support of member and provider needs. Competencies Building Trust Building a Successful Team Aligning Performance for Success Building Partnerships Customer Focus Continuous Improvement Decision Making Facilitating Change Leveraging Diversity Driving for Results Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time. Skills: Accountable leadership, Collaboration, Data-driven & Analytical, Delegation, Effective communication, Listening (active), Situational Leadership, Strategic Thinking Compensation Disclaimer The wage range provided reflects the full range for this position. The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range. Base Range: $90,052.16 - $157,591.26 Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: - We are committed to doing the right thing. - We are one team working toward a common goal. - We are each responsible for customer service. - We practice open communication at all levels of the company to foster individual, team and company growth. - We actively participate in efforts to improve our many communities-internally and externally. - We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community. - We encourage creativity, innovation, and the pursuit of excellence. Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively. Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths. The Training Specialist is responsible for designing, delivering, and maintaining comprehensive training programs that support employee development across operational functions. Key responsibilities include onboarding new hires, facilitating ongoing learning initiatives, auditing training outcomes for accuracy and effectiveness, and contributing to continuous process improvement. This role works closely with department leaders to assess training needs, align learning objectives with organizational goals, and ensure consistent knowledge transfer across teams. Essential Responsibilities: - Facilitate engaging and effective training sessions for new hires and current employees across various operational functions. - Design, update, and maintain training materials, schedules, documentation, policies, procedures, and desktop guides. - Conduct skill assessments and administer evaluations to measure training effectiveness and knowledge retention. - Audit employee work and system errors to identify performance trends and training gaps; provide actionable feedback to staff and leadership. - Deliver mentor lessons and facilitate coaching sessions to reinforce learning, build confidence, and support skill development. - Participate in testing and validation of system changes, configuration updates, and new functionality to ensure training accuracy. - Provide guidance and support to staff and internal customers by responding to questions related to operational processes and systems. - Extract and analyze data to produce reports on productivity, quality, and training outcomes. - Assist in resolving grievances, appeals, and discrepancies related to operational tasks. - Maintain positive relationships with internal teams and external vendors. - Actively participate in operational tasks when training duties are current, and support is needed. - Provide operational support when training responsibilities are current and additional assistance is needed. - Lead or contribute to process improvement initiatives and cross-functional projects. Supporting Responsibilities: - Serve as a communication liaison between individual contributors and leadership throughout training. - Meet department and company performance and attendance expectations. - Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information. - Perform other duties as assigned. SUCCESS PROFILE Work Experience: Minimum 2 years of experience within the insurance or healthcare industry. Training environment experience and CPT/ICD-10 coding preferred. Education, Certificates, Licenses: High School Diploma or equivalent Knowledge: Proficient in services performed within operations. Understanding of medical insurance and medical terminology, coding, and standard medical billing practices. Microsoft word and excel experience preferred. Proficient computer skills, typing, and 10-key required. Strong written and verbal communication skills. Knowledge of effective training and coaching strategies. Knowledge of SharePoint design. Competencies Adaptability Building Customer Loyalty Building Strategic Work Relationships Building Trust Continuous Improvement Contributing to Team Success Planning and Organizing Work Standards Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5-15% of the time. Skills: Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork Compensation Disclaimer The wage range provided reflects the full range for this position. The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range. Base Range: $44,982.98 - $71,972.77 Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: - We are committed to doing the right thing. - We are one team working toward a common goal. - We are each responsible for customer service. - We practice open communication at all levels of the company to foster individual, team and company growth. - We actively participate in efforts to improve our many communities-internally and externally. - We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community. - We encourage creativity, innovation, and the pursuit of excellence. Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively. Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths. Case management is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet the client's health and human service needs. It is characterized by advocacy, communication, and resource management and promotes quality and cost-effective interventions and outcomes. Clinicians incorporate the essential functions of professional case management concepts to enhance patients’ quality of life and maximize health plan benefits. These functions include but are not limited to: coordination and delivery of healthcare services, consideration of physical, psychological, and cultural factors, assessment of the patient’s specific health plan benefits, and additional medical, community, or financial resources available. Essential Responsibilities: - Clinician Care Managers facilitate the achievement of client wellness and autonomy through advocacy, assessment, planning, communication, education, resource management, and service facilitation. - Collect and assess patient information pertinent to patient’s history, condition, and functional abilities in order to develop a comprehensive, individualized care management plan that promotes appropriate utilization, and cost-effective care and services. - Based on the needs and values of the client, and in collaboration with all service providers, the clinician links clients with appropriate providers and resources throughout the continuum of health and human services and care settings, while ensuring that the care provided is safe, effective, client-centered, timely, efficient, and equitable. - Clinicians have direct communication among, the client, the payer, the primary care provider, and other service delivery professionals. The case manager is able to enhance these services by maintaining the client's privacy, confidentiality, health, and safety through advocacy and adherence to ethical, legal, accreditation, certification, and regulatory standards or guidelines. - Interact with other PacificSource personnel to assure quality customer service is provided. Act as an internal resource by answering questions requiring medical or contract interpretation that are referred from other departments, as well as physicians and providers of medical services and supplies. Assist employers and agents with questions regarding healthcare resources and procedures for their employees and clients. - Practice and model effective communication skills: both written and verbal. - Utilize and promote use of evidence-based tools. - Utilize lean methodologies for continuous improvement. Supporting Responsibilities: - Meet department and company performance and attendance expectations. - Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information. - Perform other duties as assigned. SUCCESS PROFILE Work Experience: Minimum of three (3) years of clinical experience, including case management. Insurance industry experience preferred. Education, Certificates, Licenses: Clinical Social Worker, Licensed Professional Counselor, or Licensed Independent Clinical Social Worker with unrestricted license required in current state of residence. OR Registered Nurse with current appropriate unrestricted state license based on line of business: Commercial and Medicare: Oregon, Idaho or Montana, and Washington; Medicaid and DSNP: Oregon. Certified Case Manager Certification (CCM) as accredited by CCMC (The Commission for Case Management) strongly desired at time of hire. CCM certification required within two years of hire. Knowledge: Knowledge of health insurance and state mandated benefits. Experience and expertise in case management practice including advocacy, assessment, planning, communication, education, resource management and service facilitation. Ability to deal effectively with people who have various health issues and concerns. Knowledge and understanding of contractual benefits and options available outside contractual benefits. Knowledge of community services, providers, vendors and facilities available to assist members. Ability to use computerized systems for data recording and retrieval. Assures patient confidentiality, privacy, and health records security. Establishes and maintains relationships with community services and providers. Maintains current clinical knowledge base and certification. Ability to work independently with minimal supervision. Competencies Adaptability Building Customer Loyalty Building Strategic Work Relationships Building Trust Continuous Improvement Contributing to Team Success Planning and Organizing Work Standards Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time. Skills: Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork Compensation Disclaimer The wage range provided reflects the full range for this position. The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range. Base Range: $70,950.00 - $106,424.99 Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: - We are committed to doing the right thing. - We are one team working toward a common goal. - We are each responsible for customer service. - We practice open communication at all levels of the company to foster individual, team and company growth. - We actively participate in efforts to improve our many communities-internally and externally. - We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community. - We encourage creativity, innovation, and the pursuit of excellence. Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively. Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

Looking for a meaningful way to make a difference in the lives of older adults? At PacificSource PACE LLC, you will be part of a team that provides compassionate, coordinated care that helps participants live safely, independently, and with dignity. Our approach honors the whole person, and that includes the people who work here. At PACE, you will join colleagues who value respect, connection, and shared purpose. We create space for every team member to contribute their strengths, grow in their role, and feel supported in the important work of caring for our community. As an equal opportunity employer, all qualified applicants will receive consideration for employment without regard to disability, veteran status, race, color, religion, sex, sexual orientation, gender identity, national origin, genetic information, age, or any other protected status. We are committed to reflecting the diversity of the communities we serve and creating a workplace where differences are celebrated and everyone can thrive. The PACE Business Analyst plays a critical role in supporting data-driven decision-making across clinical and financial operations. This position is responsible for analyzing utilization management data, evaluating HCC (Hierarchical Condition Category) coding models, coordinating the one-third Financial Audit, Part D Bid(s), reviewing IBNR (Incurred but Not Reported) claims estimates, and providing actionable insights to the Chief Medical Officer and Program Director for budgeting and financial performance. The ideal candidate will possess strong analytical skills, healthcare finance knowledge, and a deep understanding of managed care operations. Essential Responsibilities: - Analyze trends in service utilization, hospital admissions, and care coordination. - Identify cost drivers and opportunities for care optimization. - Collaborate with IT in the development of dashboards and reports to monitor key utilization metrics from both claims-based and Electronic Health Record (EHR) data. - Evaluate HCC coding trends and the impact to Per Member Per Month payments. - Collaborate with coding and clinical teams to improve risk score capture. - Collaborate with the Finance and Actuarial Teams to model financial impacts of coding changes on capitation payments. - Serve as the primary liaison for the annual Centers for Medicare and Medicaid Services (CMS) one-third Financial Audit. - Coordinate data collection, validation, and submission processes. - Participate in the development of the Part D bid. - Collaborate with compliance regarding CMS audit requirements and timelines. - Develop annual PS PACE Budget. - Review actuarial estimates of IBNR claims. - Validate assumptions and methodologies used in IBNR calculations. - Provide insights to support accurate financial forecasting and reserve setting. - Monitor and validate the accuracy of medical and pharmacy claims adjudication. - Identify and resolve discrepancies or errors in claims processing. - Reconciliation of Residential and Long Term Care services claims as compared to PACE Interdisciplinary Team authorized services. - Collaborate with the pharmacy benefit manager (PBM) and internal teams to ensure compliance with CMS guidelines and cost containment strategies. - Prepare presentations and reports for senior leadership. - Translate complex data into clear, actionable recommendations. - Support strategic planning and budget development processes. Supporting Responsibilities: - Meet department and company performance and attendance expectations. - Follow privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information. - Perform other duties as assigned. SUCCESS PROFILE Work Experience: Minimum of 3 of experience in healthcare finance, preferably in a PACE, Medicare Advantage, health system, or managed care setting. Experience working with geriatric or frail populations is preferred. Education, Certificates, Licenses: Bachelor’s degree required. Preferred areas of study: accounting, healthcare administration, finance, business, data analytics, or related field. Candidates with an associate’s degree and 2 years of relevant experience, or a high school diploma and 4 years of relevant experience, in addition to the required minimum years of work experience will also be considered. Knowledge: Strong knowledge of CMS regulations, HCC coding, and Part D financial requirements. Proficiency in data analysis tools (e.g., Excel, SQL, Workday, Power BI, Tableau). Excellent communication and presentation skills. Ability to work independently and collaboratively in a fast-paced environment. Experience with actuarial modeling or financial forecasting. Familiarity with Electronic Health Record systems and claims data structures. Understanding quality metrics and value-based care models. Each member of the PACE organization's staff that has direct contact with participants must meet the following conditions: - Be legally authorized (for example, currently licensed, registered or certified if applicable) to practice in the State in which he or she performs the function or action. - Only act within the scope of his or her authority to practice. - Have 1 year of experience working with a frail or elderly population - Meet a standardized set of competencies for the specific position description established by the PACE organization before working independently. - Be medically cleared for communicable diseases before engaging in direct participant contact. Competencies - Adaptability - Building Customer Loyalty - Building Strategic Work Relationships - Building Trust - Continuous Improvement - Contributing to Team Success - Planning and Organizing - Work Standards Environment: Work inside in general office and clinical settings with ergonomically configured equipment. Travel is required approximately 10% of the time. Skills: Compensation Disclaimer The wage range provided reflects the full range for this position. The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range. Base Range: $58,074.38 - $92,919.03 Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: - We are committed to doing the right thing. - We are one team working toward a common goal. - We are each responsible for customer service. - We practice open communication at all levels of the company to foster individual, team and company growth. - We actively participate in efforts to improve our many communities-internally and externally. - We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community. - We encourage creativity, innovation, and the pursuit of excellence. Physical Requirements: Work is performed in a clinic setting with typical healthcare exposures, including contact with bodily fluids, infectious diseases, and cleaning chemicals; PPE is provided and required. The role involves stooping, bending, sitting, standing, and moving between clinical areas for extended periods. May assist participants with mobility, including guiding, supporting, escorting, and occasional transfer assistance using proper body mechanics. Must be able to lift, push, pull, or carry up to 35 pounds occasionally and perform frequent repetitive motions such as typing and operating medical or office equipment. Some positions require occasional travel to PACE sites, participant homes, or external appointments. Must be able to speak clearly, understand verbal instructions, and interact professionally with participants, caregivers, and staff. Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.