Dental Claims Processor I

About the Company

Moda is an Oregon-based organization founded in 1955, built around a people-first approach and a focus on quality. The company’s mission centers on improving healthcare for members, supporting the community with compassion, and providing strong benefits for employees. Moda also emphasizes diversity and inclusion and welcomes applicants who share that commitment.

Role Overview

This position is responsible for reviewing dental claims that did not automatically adjudicate, identifying why they were pended, making needed corrections, and processing them in line with claim rules and contract terms. The role is based in a hybrid work setup in Milwaukie, Oregon.

Compensation

The hourly pay range for this role is $17.34 to $18.36, depending on experience. Candidates who do not meet the minimum requirements will be considered only at the lower end of the range. Pay is determined by qualifications.

Benefits

Employees are offered medical, dental, vision, pharmacy, life, and disability coverage, along with a 401(k) match, FSA, an employee assistance program, paid time off, and company-paid holidays.

Responsibilities

• Review claims that have stopped in the system, determine why they did not auto-adjudicate, and process them using the correct contract and policy rules.
• Apply group-specific and standard benefits by using contract notes and processing guidelines.
• Verify eligibility, assess whether a claim qualifies for benefits, and enter information so the correct payment is issued.
• Analyze claim documentation and notes, and record information clearly and accurately.
• Issue clinical requests and letters asking for missing information when needed.
• Perform basic manual benefit calculations when the situation requires it.
• Investigate pended claims to understand the reason for the hold.
• Complete other assigned duties as needed.

Requirements

• High school diploma or equivalent.
• Ability to type at least 35 net words per minute on a computer keyboard.
• 10-key proficiency of 105 kspm net on a numeric keypad.
• Capability to meet and maintain quality and productivity expectations.
• Legible handwriting.
• Preferred familiarity with dental terminology and ADA codes.
• Preferred background in data entry involving different plan and claim types.
• Strong reading, verbal, and written communication skills.
• Ability to listen carefully, communicate clearly, and interact in a professional, patient, and courteous way with coworkers and supervisors.
• Good analytical, problem-solving, and decision-making abilities.
• Strong attention to detail and memory retention, with the ability to shift priorities.
• Well-developed organizational skills and the ability to handle pressure while meeting deadlines.
• Ability to interpret contracts and apply Moda policies and procedures to claims work.
• Dependable attendance, including punctuality and consistent daily presence.
• Ability to maintain confidentiality and present a professional business image.
• Must have a reliable, high-speed, hard-wired internet connection for remote or hybrid work.
• Must be comfortable appearing on camera for virtual training and meetings.
• Willingness to work beyond the standard schedule, including evenings and occasional weekends, based on business needs.
• Office-based work environment involving extended computer and keyboard use, frequent phone communication, constant sitting, and the ability to move across multiple screens.
• Internal collaboration with Imaging Services, Claim Support, and Professional Relations teams.

Additional Information

Moda Health values equal employment opportunity and considers all qualified applicants without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status, or any other legally protected status. This applies to all employment terms, including hiring, promotion, compensation, training, leave, layoff, recall, transfer, and termination. Accommodation questions may be directed to Kristy Nehler and Danielle Baker via the company human resources email.

Application Note

Applications must be submitted through the company’s application process to be considered.