Moda Health
Join to apply for the
Medical Customer Service Representative
role at
Moda Health .
Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. We focus on building a better future for healthcare by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees.
Position Summary Provides phone customer service to members of multiple benefit plans by analyzing caller’s needs and providing timely and accurate responses. Answers calls from policyholders, members, agents, providers, hospitals, pharmacists and others regarding a wide variety of issues and questions related to a member’s health plan. Includes explaining benefits, claims processing and other details of the plan. This is a full‑time WFH position.
Pay Range $19.00 - $20.00 per hour DOE. Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will receive the low end of the pay range.
Application Link https://j.brt.mv/jb.do?reqGK=27768218&refresh=true
Benefits
Medical, Dental, Vision, Pharmacy, Life, & Disability
401K – Matching
FSA
Employee Assistance Program
PTO and Company Paid Holidays
Schedule
Monday - Friday
Full time minimum 7.5 work days with 37.5 work weeks
Requirements
High school diploma or equivalent.
Practical knowledge of medical terminology desired.
Knowledge of 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. Ability to interact professionally, patiently, and courteously with customers over the phone.
Good analytical, problem solving and decision‑making skills.
10‑key proficiency of 105 spm net on a computer numeric keypad.
Typing speed of at least 25 wpm net on a computer keyboard.
High speed internet (cable or fiber).
Proficiency with Microsoft Office applications and ability to open and navigate multiple windows simultaneously.
Ability to achieve and maintain quality and quantity standards.
Ability to work well under pressure in a complex and rapidly changing environment.
Ability to be on time and present daily.
Maintain confidentiality and project a professional business presence.
Ability to repeatedly analyze situations and communicate effectively in a fast‑paced environment that includes dealing with angry people.
Ability to organize and remain up to date on changing and new information.
Primary Functions
Answers 50+ calls a day regarding claims and benefit questions from callers on both group and individual plans. Provides solutions to problems, confirms eligibility, verifies premiums and collects payments for members on individual plans, explains benefits and/or plan coverage.
Communicates effectively in a fast‑paced environment that includes dealing with frustrated or angry callers.
Provides accurate information in a professional manner.
Applies mathematical skills to determine correct benefit information and premium amounts for individual plans.
Exercises judgment, initiative, and discretion in confidential and sensitive matters.
Performs related duties:
Review, update and become familiar with new and revised benefit information or claim processing procedures.
Review and explain any authorization requirements of the plan using online tools available.
Update and enter primary care physician selections if required by member’s plan.
Gather banking details so monthly premium for members on individual plans can be collected.
Request claim adjustments when errors occur or new information received.
Resolve and record complaints, appeals, and inquiries.
Complete provider searches using online web‑based systems to assist members in finding suitable providers.
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 required.
Document all aspects of a call in a clear and concise manner.
Answer calls within service level time.
Other duties and projects as assigned by Manager/Supervisor/Lead.
Equal Employment Opportunity 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. This is applicable to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absences, compensation, and training.
For more information regarding accommodations please direct your questions to Kristy Nehler and Danielle Baker via our humanresources@modahealth.com email.
Seniority Level Entry level
Employment Type Full‑time
Job Function Other
Industries Insurance
#J-18808-Ljbffr
Medical Customer Service Representative
role at
Moda Health .
Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. We focus on building a better future for healthcare by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees.
Position Summary Provides phone customer service to members of multiple benefit plans by analyzing caller’s needs and providing timely and accurate responses. Answers calls from policyholders, members, agents, providers, hospitals, pharmacists and others regarding a wide variety of issues and questions related to a member’s health plan. Includes explaining benefits, claims processing and other details of the plan. This is a full‑time WFH position.
Pay Range $19.00 - $20.00 per hour DOE. Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will receive the low end of the pay range.
Application Link https://j.brt.mv/jb.do?reqGK=27768218&refresh=true
Benefits
Medical, Dental, Vision, Pharmacy, Life, & Disability
401K – Matching
FSA
Employee Assistance Program
PTO and Company Paid Holidays
Schedule
Monday - Friday
Full time minimum 7.5 work days with 37.5 work weeks
Requirements
High school diploma or equivalent.
Practical knowledge of medical terminology desired.
Knowledge of 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. Ability to interact professionally, patiently, and courteously with customers over the phone.
Good analytical, problem solving and decision‑making skills.
10‑key proficiency of 105 spm net on a computer numeric keypad.
Typing speed of at least 25 wpm net on a computer keyboard.
High speed internet (cable or fiber).
Proficiency with Microsoft Office applications and ability to open and navigate multiple windows simultaneously.
Ability to achieve and maintain quality and quantity standards.
Ability to work well under pressure in a complex and rapidly changing environment.
Ability to be on time and present daily.
Maintain confidentiality and project a professional business presence.
Ability to repeatedly analyze situations and communicate effectively in a fast‑paced environment that includes dealing with angry people.
Ability to organize and remain up to date on changing and new information.
Primary Functions
Answers 50+ calls a day regarding claims and benefit questions from callers on both group and individual plans. Provides solutions to problems, confirms eligibility, verifies premiums and collects payments for members on individual plans, explains benefits and/or plan coverage.
Communicates effectively in a fast‑paced environment that includes dealing with frustrated or angry callers.
Provides accurate information in a professional manner.
Applies mathematical skills to determine correct benefit information and premium amounts for individual plans.
Exercises judgment, initiative, and discretion in confidential and sensitive matters.
Performs related duties:
Review, update and become familiar with new and revised benefit information or claim processing procedures.
Review and explain any authorization requirements of the plan using online tools available.
Update and enter primary care physician selections if required by member’s plan.
Gather banking details so monthly premium for members on individual plans can be collected.
Request claim adjustments when errors occur or new information received.
Resolve and record complaints, appeals, and inquiries.
Complete provider searches using online web‑based systems to assist members in finding suitable providers.
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 required.
Document all aspects of a call in a clear and concise manner.
Answer calls within service level time.
Other duties and projects as assigned by Manager/Supervisor/Lead.
Equal Employment Opportunity 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. This is applicable to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absences, compensation, and training.
For more information regarding accommodations please direct your questions to Kristy Nehler and Danielle Baker via our humanresources@modahealth.com email.
Seniority Level Entry level
Employment Type Full‑time
Job Function Other
Industries Insurance
#J-18808-Ljbffr