customer support
Posted Jun 12Medical Claims Support I
at Moda Health
Hybrid
Responsibilities
- Review, analyze, and resolve claims issues through the utilization of available resources for moderately complex claims.
- Analyze and apply plan concepts to claims that include deductible, coinsurance, copay, COB, and out of pocket, etc.
- Release claims and adjustments by deadline to meet company, state regulations, contractual agreements, and group performance guarantee standards.
- Perform other duties as assigned.
Requirements
- High School diploma or equivalent.
- experience as a Processor I and consistently performing at an exceeding level of performance. Support Processor I designation may also be obtained through equivalent work
- experience and knowledge level at Moda Health or when recruiting externally.
- 10-key proficiency of 135 wpm net on a computer numeric keypad.
- Ability to show a pattern of maintaining balanced performance, which consistently exceeds expectations in areas of production and quality.
- Strong and proficient organizational abilities and the ability to handle a variety of functions
- Ability to efficiently multitask and work well under pressure and meet timelines.
- Strong analytical, problem solving, decision making and detail-oriented skills with ability to shift priorities as needed.
- Strong proficiency in claims processing systems; Facets, Word, and Excel.
- Excellent knowledge and understanding of Moda Health administrative policies affecting claims and customer service.
- Performs basic and moderately complex claim adjustments within the system while interpreting coding and understanding medical terminology in relation to diagnosis and procedures as well as member plan benefits.
- Performs all job functions with a high degree of discretion and confidentiality in compliance with federal, state, and departmental confidentiality guidelines.
- Must be able to navigate multiple computer screens.
- A reliable, high-speed, hard-wired internet connection required to support remote or hybrid work.
- This is a beta feature to avoid spam applicants.
Benefits
- Investigates and processes claim adjustments for all medical lines of business and COB claim adjustments for Medicare/Medicaid plans.
- This is a FT WFH role. Pay Range
- $21.30 - $23.96 hourly, DOE.
- Actual pay is based on qualifications. Applicants who do not exceed the minimum
- qualifications will only be eligible for the low end of the pay range.
- Medical, Dental, Vision, Pharmacy, Life, & Disability 401K- Matching FSA
- PTO and Company Paid Holidays Required Skills,
- Communicates via telephone with claimants, policyholders, providers, and other insurance carriers.
- Externally with Providers, Members, Vendors, and Insurance companies.
- 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.
Contact
- https://j.brt.mv/jb.do?reqGK=27778915&refresh=true Benefits
- For more information regarding accommodations, please direct your questions to Kristy Nehler & Danielle Baker via our humanresources@modahealth.com email.
Additional details
- Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality.
- Today, like then, weâre 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.
- Moda values diversity and inclusion in our workplace.
- We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity.
- Our diverse experiences and perspectives help us become a stronger organization.
- Also processes adjustments related to overpayment recovery, underpayment adjustments and other corrections.
- Performs COB updates (excluding Commercial), file reviews, issues adjustment related letters to members and providers, performs payment offsets and also validates and completes stop payment requests.
- Assists in customer service inquiries regarding contractual and administrative policies and applies excellent customer service when a phone call is needed to complete an adjustment or other support work.