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.

Follow the link below and complete an application for this position.

• https://j.brt.mv/ATS/jb.do?reqGK=27693508

Benefits:

• Medical, Dental, Vision, Pharmacy, Life, & Disability
• 401K- Matching
• FSA
• Employee Assistant Program
• PTO and Company Paid Holidays

• PST

Required Skills, Experience & Education:

• High School diploma or equivalent.
• 2 – 3 years medical/dental claim processing or customer service dealing with all types of plans/claims.
• Professional and effective written and verbal communication skills.
• Good analytical, problem solving, decision making and organizational, and detail-oriented skills with ability to shift priorities.
• 10-key proficiency of 105 spm.
• Type a minimum of 45 wpm.
• Good organizational ability to work under pressure to handle variety of functions and meet timelines.
• Ability to maintain confidentiality and project a professional business image.
• Ability to come into work on time and on a daily basis.
• Proficient with Facets, Word, and Excel.

• Prices and processes medical claims with outside vendors including First Choice, IPN, Healthy Directions, PHCS-PPO, and First Health.
• Work closely with Medical Professional Relations, Customer Service, and Support on pricing requests.
• Able to differentiate between all plan types when processing claims for multiple groups.
• Identify inconsistencies with network setups.
• Contacts outside vendors related to pricing and website issues.
• Review, analyze and resolve claims through the utilization of available resources including P&Ps, member handbooks, provider contracts, and EBT.
• Complete complex file reviews associated with network pricing.
• Handle claim adjustments related to network pricing.
• Assist with Member and Providers Appeals related with network pricing.
• Other duties as assigned

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.

For more information regarding accommodations please direct your questions to Kristy Nehler and Daniel McGinnis via our humanresources@modahealth.com email.