Full-Time

Quality Assurance Analyst

Health-Related Social Needs

CareOregon

CareOregon

501-1,000 employees

Managed care with social support programs.

No salary listed

Portland, OR, USA

Hybrid

Hybrid role; 1x/week on-site in downtown Portland; must reside in Portland Metro.

Category
QA & Testing
Required Skills
Sharepoint
Workday HRIS
Excel/Numbers/Sheets
Requirements
  • Minimum 2 years’ experience in data quality assurance to include data entry, tracking, and reporting
  • Minimum 4 years’ experience in Medicaid, health plan operations, or managed care organizations
  • Experience with regulation and applying rules to a process
  • Working knowledge of Microsoft Office system, including intermediate Excel skills
  • Knowledge of basic medical terminology
  • Knowledge of care management platforms and experience with documenting in care management or similar platform
  • Knowledge and experience with Federal, State and Local regulations and HIPAA privacy rules and regulations
  • Strong organizational skills
  • Attention to detail
  • Familiarity with Medicaid claims billing and coding
  • Computer skills and ability to learn new technology quickly
  • Ability to use good judgment, personal initiative and discretion to perform work with particular attention to detail
  • Ability to effectively interact with individuals at all levels internal and external to the organization
  • Good written and verbal communication skills
  • Good customer service skills
  • Basic teamwork skills
  • Ability to manage multiple tasks
  • Ability to work in a fast-paced environment
  • Ability to work effectively with diverse individuals and groups
  • Ability to learn, focus, understand, and evaluate information and determine appropriate actions
  • Ability to accept direction and feedback, as well as tolerate and manage stress
  • Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
  • Ability to hear and speak clearly for at least 3-6 hours/day
Responsibilities
  • Conduct timely and accurate quality assurance reviews of member benefit allocations prior to payment, ensuring alignment with state and federal regulations and CareOregon policies
  • Review supporting documentation and system data to validate eligibility, benefit limits, accuracy of calculations, and appropriateness of payment amounts
  • Identify trends, patterns, and root causes of errors; proactively recommend corrective actions to improve quality, consistency, and productivity
  • Research claim, invoice, enrollment, and benefit processing issues to determine source, contributing factors, and appropriate resolution, escalating issues as needed
  • Collaborate with the Rent Assistance team to reduce rework by clarifying requirements, identifying gaps in documentation, and recommending process or workflow improvements
  • Develop, maintain, and distribute summary-level, quality assurance, and performance reports for leadership and the Oregon Health Authority (OHA)
  • Analyze data and quality review results to identify improvement opportunities, compliance risks, and training needs
  • Track corrective actions and outcomes to assess effectiveness of improvement efforts over time
  • Support audits, inquiries, and data requests by preparing accurate documentation and responsive analyses
  • Support the development and delivery of training materials, job aids, and guidance to proactively address quality trends, common errors, and policy updates
  • Partner with management and cross-functional teams to ensure quality assurance reviews remain effective, relevant, and aligned with organizational needs
  • Participate in meetings and workgroups related to HRSN benefits, rent assistance operations, and quality improvement initiatives
  • Perform accurate and timely data entry and accounting-related support, including reviewing invoices, ledgers, rental statements, and utility bills to determine eligible reimbursement or payment amounts in accordance with benefit policies and procedures
  • Ensure all documentation is complete, properly stored, and accessible for reporting, audit, and compliance purposes
  • Utilize technology systems and databases effectively for documentation, quality tracking, reporting, and communication
  • Use standard Microsoft Office applications (Excel, Word, PowerPoint, Outlook), SharePoint, Workday, Unite Us, and other applicable systems to create and maintain documents, spreadsheets, charts, graphs, and reports
  • Independently manage special projects or ad hoc assignments as assigned, including process reviews, data clean-up efforts, and pilot initiatives

CareOregon runs a health plan in Oregon that helps hundreds of thousands of people get medical care and also funds programs that address social needs like housing, healthy food, and job training. Its product works by providing health coverage and access to services through a Member-focused program, while also financing community initiatives that support overall well-being. What sets CareOregon apart is its emphasis on social determinants of health and the wider “CareOregon Effect”—improving people’s lives beyond medical care and focusing on community impact. The company’s goal is to improve health outcomes for its members and strengthen the broader community by investing in multiple services that support stable housing, nutrition, work skills, and more.

Company Size

501-1,000

Company Stage

N/A

Total Funding

N/A

Headquarters

Portland, Oregon

Founded

1994

Your Connections

People at CareOregon who can refer or advise you

Simplify Jobs

Simplify's Take

What believers are saying

  • The May 2026 Torch Journey raises CareOregon's visibility before Portland's June 6 Walk.
  • Workforce programs with FolkTime and ACHF address Oregon's provider shortages directly.
  • Hawk's Eye Apartments shows CareOregon can link housing, staffing, and care access.

What critics are saying

  • Medicaid reimbursement cuts force more layoffs and weaken care management capacity.
  • The failed SCAN merger shows regulators block CareOregon's scale strategy.
  • CareOregon's new community programs depend on outside funding and stay vulnerable to cuts.

What makes CareOregon unique

  • CareOregon combines Medicaid managed care with community health investments across Oregon.
  • It launched Oregon's only OHSU Preventive Medicine Residency with CareOregon support.
  • New leaders Dee Cruz and Peter Lymm strengthen finance and operations discipline.

Help us improve and share your feedback! Did you find this helpful?

Benefits

Hybrid Work Options

Wellness Program

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

Health Savings Account/Flexible Spending Account

Paid Vacation

PTO/vacation

Paid Holidays

Paid Sick Leave

Paid State Sick Time

401(k) Retirement Plan

401(k) Company Match

Flexible Work Hours

Remote Work Options

Pension?

Employee Assistance Program

Wellness Program

Phone/Internet Stipend

Home Office Stipend

Family Planning Benefits

Fertility Treatment Support

Stock Options

Company Equity

Conference Attendance Budget

Professional Development Budget

Mentorship Program

Tuition Reimbursement

Education allowance

Training Programs

Professional Certification Support

Legal Services

Pet Insurance

Adoption Assistance

Childcare Support

Elder Care Support

Meal Benefits

Employee Discounts

Relocation Assistance

Commuter Benefits

Meal Benefits

Adoption Assistance

Bereavement Leave

Company News

CareOregon
Feb 23rd, 2026
CareOregon welcomes Dee Cruz as Chief Finance and Strategy Officer

CareOregon welcomes dee Cruz as Chief Finance and Strategy Officer. Published February 23, 2026 CareOregon announced today that Diana (Dee) Cruz will join the organization as Chief Finance and Strategy Officer, effective February 23. Cruz brings extensive experience in health plan finance, operations and enterprise strategy. Most recently, she served as Acting President and Chief Operating Officer at WellSense Health Plan, where she oversaw strategy and operations supporting Medicare, individual and Medicaid plans serving more than 700,000 members across Massachusetts and New Hampshire. Prior to joining WellSense, Cruz initiated the Office of Consumer Obsession at Cambia Health Solutions, sponsoring enterprise programs focused on reducing consumer effort and health care costs. She previously served as Vice President of Operations at Regence Blue Cross Blue Shield and held leadership roles at Cigna across finance, operations and network architecture. "CareOregon has navigated a period that required discipline and difficult choices to ensure long-term sustainability," said Eric C. Hunter, President and CEO of CareOregon. "Dee brings strong financial leadership and strategic experience that will support our continued focus on stewardship and accountability." As Chief Finance and Strategy Officer, Cruz will oversee CareOregon's finance and enterprise strategy functions, ensuring alignment between financial performance and long-term organizational priorities. "I'm honored to join CareOregon at this important moment," said Cruz. "The organization plays a vital role in Oregon's health care system. I look forward to listening, learning and working with the team to strengthen financial stewardship and strategic alignment in support of our members."

CareOregon
Jan 26th, 2026
Strengthening Oregon's health care workforce: Preparing for tomorrow, today

Strengthening Oregon's health care workforce: preparing for tomorrow, today. The power of Medicaid at work. Across United States, health care faces a "perfect storm" of challenges - workforce shortages, rising care costs and widening disparities in health outcomes. In Oregon, these problems are amplified by a mental health crisis and limited access to care. While barriers exist statewide, they look different depending on where you live. Rural communities often face higher poverty rates and have fewer specialists, while urban areas grapple with provider burnout. CareOregon is committed to strengthening the health care workforce across Oregon, investing in programs and services that support both urban and rural communities. That commitment starts with investing in people and building a workforce pipeline that prepares future health leaders, strengthens rural health systems and supports community based care. Addressing workforce shortages isn't only about filling today's open roles. It's also about thinking ahead, preparing leaders who can prevent tomorrow's health crises and reduce strain on an overburdened system. Going upstream with the OHSU Preventive Medicine Residency program. CareOregon partnered with the Oregon Health & Science University (OHSU) to launch the Preventive Medicine Residency, a pioneering program that trains physicians for leadership roles in public health, policy and research. The program addresses workforce challenges by preparing doctors to think beyond individual patient care and focus on population-level health and prevention - essential for improving health outcomes. The Program's first cohort includes Tiantian White, MD, a family physician who grew up in rural China and saw firsthand how a lack of access to health care could have dire outcomes. "My family never had proper health care. There were so many downstream negative consequences when things became severe," Dr. White remembers. For example, her father's finger was injured and then amputated by someone without proper training. This led to an infection because it wasn't properly bandaged - resulting in a hospital stay. Experiences like this inspired White to go into preventive medicine to reduce health disparities and improve systems of care for vulnerable populations. "These are the most mission-oriented, value-driven folks I've met in my career so far," says White. "Everyone is working so hard and is passionate about what they do, despite all the looming challenges." While programs like OHSU's Preventive Medicine Residency focus on preparing physician leaders with skills and knowledge to achieve long-term public health goals, many rural communities across Oregon are currently facing more urgent and severe health care workforce shortages. Expanding rural access through Ashland Community Health Foundation. In southern Oregon, Jackson Care Connect (JCC), a coordinated care organization serving Jackson County, is part of the CareOregon family of companies. JCC partners with Ashland Community Health Foundation (ACHF) to address critical workforce gaps in the region. In this part of the state, workforce shortages can directly impact how quickly and where community members are able to receive care. Your support plays a crucial role in enhancing my efforts to foster people in recovery. Stephanie Roland, ACHF's Executive Director, says the area faces shortages at every level of the health care workforce, from medical assistants and behavioral health clinicians to specialists and emergency medical technicians (EMTs). This can lead to long wait times, even tougher to manage for the area's significant aging population. Median wait times often exceed two weeks for primary care and can reach up to 58 days for specialists. With most services concentrated in Medford, about 15 miles away, access can be especially difficult for patients without a car or reliable public transportation. I think [its nursing scholarship] will become even more important now that advanced nursing degrees are no longer deemed 'professional.' To ease pressure on emergency departments and make better use of limited capacity, ACHF is supporting a new partnership with Mercy Flights that allows EMTs to respond to 911 calls even when emergency or hospital care isn't required. Under protocols designed by Mercy Flights' medical director, eligible patients can choose to be transported to participating urgent care clinics instead of the hospital emergency department. The model helps reduce overcrowding, shortens wait times, and ensures patients receive timely, appropriate care while preserving critical resources for life-threatening emergencies. Investments from CareOregon and other donors have also helped ACHF expand behavioral health workforce pathways, including scholarships for future clinical mental health counselors, behavioral health internships, and continuing education for peer support specialists who plan to stay in the community. Together, these efforts help ensure that people who train in the region can continue serving their neighbors, which improves and strengthens access to care. Even with expanded clinical and emergency capacity, many Oregonians still need support navigating complex health systems from someone in their own community who knows what they're going through. Building community health capacity with FolkTime. Peer support specialists, community health workers and personal health navigators play a growing role in filling workforce gaps in the health care ecosystem, and can be vital partners in addressing challenges alongside traditional models of care. FolkTime is Oregon's oldest and longest-running peer-run organization, equipping individuals with the skills and tools to offer non-clinical support to peers for mental health and substance use disorder (SUD). CareOregon helps fund FolkTime's peer support specialist training program, along with the state's only personal health navigator training program providing in-person support outside of the Portland metro area, ensuring rural communities have trusted guides to help navigate complex health systems. "Rural spaces are in desperate need of trusted people in their community to help navigate complex health systems," notes Peter Starkey, Executive Director of FolkTme. "One of our focuses when it came to our commitment to equity was also geographic equity. A lot of people outside of the Portland-Salem area don't get access to professional development." For patients frustrated by provider shortages and long wait times, traditional health workers - which includes peer support specialists, community health workers and personal health navigators - can serve as a bridge and provide the support needed, right in their own community. What's more, traditional health worker training programs are often brief, allowing graduates to begin assisting community members shortly after acquiring the necessary knowledge and skills. "They are making people feel seen and heard, especially in a system where it can feel like you're not being heard," Starkey adds. The traditional health care workforce is also flexible, meaning peers can support others in a variety of settings, including within the prison system, housing services and mental health system, creating a web of support across communities. So far, FolkTime has trained over 5,000 peer support specialists in Oregon. "Connection is what cures everything - conflict, addiction, mental health struggles," Starkey emphasizes. "If we can connect with people more in our everyday lives, we'll be a much less lonely society." Why Medicaid matters in Oregon. From preventive medicine physicians to rural EMTs and peer support specialists, Medicaid helps make workforce investments like the ones highlighted here possible. By investing in innovative programs, initiatives and services like these, CareOregon is helping address today's health challenges while training the next generation of health care workers to bring tomorrow's solutions. But programs like these, many of which are relatively new, depend on stable, long-term funding - primarily from Medicaid. Changes in that funding source could cause many initiatives like these to be scaled back or disappear entirely. I don't think that philanthropy [alone] can be a solution for systems that have been eroded - it needs to be both. Investing in building and strengthening the health care workforce at every level helps ensure communities across Oregon are better equipped to meet current needs and the challenges ahead. Investments in Action series. Its "Investments in Action" series highlights the transformative power of CareOregon's strategic investments in health and wellbeing. Through these stories, CareOregon, Inc. explore how its support goes beyond traditional funding roles and is helping to close gaps in health care access and community services. Despite challenges within the Medicaid space, CareOregon, Inc. remain committed to centering these important narratives of community strength and resilience.

CareOregon
Jan 23rd, 2026
CareOregon welcomes Peter Lymm as Chief Operations Officer

CareOregon welcomes Peter Lymm as Chief Operations Officer. CareOregon announced today that Peter Lymm has joined the organization as Chief Operations Officer. Lymm brings more than 30 years of senior health care leadership experience across nonprofit health plans, provider organizations and health care technology. Most recently, he served as Western Region Market President at P3 Health Partners, where he led market-level operations and supported value-based care delivery in complex, multi-payer environments. Prior to that, he served as Chief Operations Officer at Neighborhood Health Plan of Rhode Island, a nonprofit Medicaid and Medicare health plan. "CareOregon has navigated a period that required difficult but necessary decisions to ensure long-term sustainability," said Eric Hunter, President and CEO of CareOregon. "As we move forward, strengthening our operational leadership is critical. Peter Lymm brings deep experience and a strong stewardship mindset that will support execution and stability in service of our mission." As COO, Lymm will oversee CareOregon's core operational functions, with a focus on aligning systems, teams and processes to support members and partners across Oregon. "I'm honored to join CareOregon at this important moment," said Peter Lymm. "The organization plays a vital role in Oregon's health care system. I'm looking forward to listening, learning and working alongside the team to strengthen operations and support CareOregon's long-term success."

RamaOnHealthcare
Aug 20th, 2025
26 payers cutting jobs | 2025

CareOregon laid off 80 employees and eliminated 70 empty positions in July response to financial headwinds.

KOBI-TV NBC5 / KOTI-TV NBC2
Oct 1st, 2024
ACHF receives $1M grant to establish a Health Care Workforce Training Fund

ASHLAND, Ore.- The Ashland Community Health Foundation receives a $1 million grant from CareOregon to establish the Health Care Workforce Training Fund.