Job Description
Let’s do great things, together!About ModaFounded 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. 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. Let’s be better together.Position SummaryInvestigates and processes claim adjustments for all medical lines of business and COB claim adjustments for Medicare/Medicaid plans. 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. 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.Please fill out an application on our company page, linked below, to be considered for this position.https://j.brt.mv/jb.do?reqGK=27778915&refresh=trueBenefitsMedical, Dental, Vision, Pharmacy, Life, & Disability401K- MatchingFSAEmployee Assistance ProgramPTO and Company Paid HolidaysRequired Skills, Experience & EducationHigh School diploma or equivalent.Minimum of 6 months medical claim processing or customer service dealing with all types of plans/claims and consistently exceeding performance levels At least 12 months 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.Professional and effective written and verbal communication skills10-key proficiency of 135 wpm net on a computer numeric keypad.Type a minimum of 35 wpm net on a computer keyboard.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.Ability to maintain confidentiality internally and externally and pr
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