Moda Employee Plan Claims Processor and CSR - Remote
Full Time
Portland, OR 97204
Posted
Job description
Let’s do great things, together
Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together.
This position will process Moda employee plan claims including COB claims and adjustments while providing exceptional customer service to our members. This position will answer phone calls from members, and providers, including hospitals, DME providers, pharmacies, and others regarding benefits. This position requires strong problem-solving and excellent communication skills.
This is a remote position for candidates currently living in or are willing to move to the following States: AK, AZ, FL, ID, NJ, TX, WA.
Primary Functions:
Requirements:
Benefits:
Together, we can be more. We can be better.
Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law.
Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together.
This position will process Moda employee plan claims including COB claims and adjustments while providing exceptional customer service to our members. This position will answer phone calls from members, and providers, including hospitals, DME providers, pharmacies, and others regarding benefits. This position requires strong problem-solving and excellent communication skills.
This is a remote position for candidates currently living in or are willing to move to the following States: AK, AZ, FL, ID, NJ, TX, WA.
Primary Functions:
- Answers claim benefit questions from callers on both our Medical and Dental products. Provides solutions to problems, confirm eligibility, and explain benefits and/or plan coverage.
- Ability to repeatedly analyze situations, and communicate effectively, in a fast-paced environment that includes dealing with angry people.
- Provide accurate information in a professional manner.
- Apply mathematical skills to determine correct benefit information.
- Exercise judgment, initiative, and discretion in confidential and sensitive manners.
- Performs related duties:
- Review, update and become familiar with new and revised benefit information or claim processing procedures.
- Update and enter primary care physician selections and coordinate with Group Integration.
- Process claims
- Complete adjustments
- Resolve and record complaints, appeals, and inquiries.
- Contact physicians, dentists, hospitals, and other providers when necessary to answer questions and obtain or provide information.
- Provide timely follow-up and return calls when these are required.
- Answers calls within service level time.
- Perform other related duties as assigned.
- Assist in training on CSR I’s when requested by supervisor and/or lead.
Requirements:
- High school diploma or equivalent.
- At least 12 months of experience as a Moda CSR I or as a medical claim processor and performing at an overall satisfaction level of performance. CSR II designation may also be obtained through equivalent work experience and knowledge level at Moda or when recruiting externally.
- Practical knowledge of medical terminology desired.
- Knowledge of the diagnosis and procedure coding desired.
- Claim processing experience or prior customer service experience or other related experience such as medical/dental office experience.
- Excellent oral and written communication skills and ability to interact professionally, patiently, and courteously with customers over the phone and in person.
- Good analytical, problem-solving, and decision-making skills.
- 10-key proficiency of 105 wpm net on a computer numeric keypad.
- Type a minimum of 25 wpm net on a computer keyboard.
- Ability to work well under pressure in a complex and rapidly changing environment.
- Maintain confidentiality and project a professional business presence and appearance.
- Ability to come to work on time and daily.
- Knowledge and understanding of State and Federal legislation and Moda administrative policies affecting claims.
- Handle 25+ calls per day in addition to processing and adjusting claims.
- Demonstrated ability to comply with company rules and policies.
- Maintain attendance at or above company standards.
- Demonstrated ability to handle difficult calls and benefits issues with little assistance.
Benefits:
- Medical, Dental, Vision & Pharmacy
- 401K and FSA
- PTO and company paid holidays
Together, we can be more. We can be better.
Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law.
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