Health Navigator I

About Moda Health

Established in 1955 in Oregon, Moda Health is dedicated to providing exceptional healthcare coverage and benefits. The company fosters a workplace culture that values diversity and inclusion, welcoming candidates who share these commitments. Moda collaborates to build healthier communities and workplaces.

Job Overview

The Health Navigator I role involves assisting members from specific Performance Guarantee and Moda 360 plans through phone, email, and chat. The position requires analyzing inquiries related to member benefits and health program options and providing prompt, accurate responses. Flexibility in work schedule is necessary to align with client demands.

Key Responsibilities

• Handle medical, dental, and/or pharmacy inquiries from members, providers, and other stakeholders across various communication channels including phone, email, chat, and voicemails.
• Conduct comprehensive research using multiple internal systems to resolve member questions and issues thoroughly.
• Collaborate with internal departments and external parties to coordinate resolution and communicate member needs effectively.
• Utilize the Moda 360 Navigator Console to recommend personalized health programs and assist members with participation.
• Process claims and benefits accurately, applying analytical and critical thinking skills to ensure complete resolution.
• Manage confidential information with professionalism and discretion.
• Engage with members to explain benefits, coverage options, provider networks, and address complaints, appeals, and grievances.
• Maintain proficiency in relevant software and platforms, and complete ongoing training including certification.
• Support other related duties and projects as assigned by supervisors or leadership.

Requirements

• High school diploma or equivalent educational qualification.
• Successful completion of Moda Health’s Customer Service Representative training program.
• Prior experience in claim processing, customer service, or related fields such as medical, dental, or pharmacy offices is preferred.
• Familiarity with medical, dental, and pharmacy terminology; knowledge of diagnosis and procedure coding is advantageous.
• Strong verbal and written communication capabilities, demonstrating patience and professionalism in all interactions.
• Excellent problem-solving, analytical, and decision-making skills.
• Typing proficiency: minimum 25 words per minute and 10-key numeric input at 105 kpm net.
• Ability to operate multiple applications on multiple monitors efficiently and adapt to technology changes.
• Experience with Microsoft Office tools such as Outlook, OneNote, and Teams; knowledge of TriZetto Facets is beneficial.
• Capability to work effectively under pressure in a dynamic environment while maintaining punctuality and attendance.
• Commitment to confidentiality and professional appearance.
• Self-motivated with ability to learn independently and improve skills continuously.
• Internal candidates must meet or exceed performance expectations, particularly in accuracy and customer service areas.
• Successful completion of Effortless Experience training and certification after hire.

Work Environment & Interactions

• Primarily seated with extensive computer and telephone use, requiring multitasking across applications and documentation while interacting with callers.
• Frequent communication with various internal departments and external contacts including providers, pharmacists, policyholders, brokers, and other insurance carriers.

Compensation & Benefits

• Hourly pay range of $21.30 to $23.96, based on candidate qualifications; lower pay applies to those not meeting minimum requirements.
• Comprehensive benefits package including medical, dental, vision, pharmacy, life insurance, disability, 401K matching, FSA, Employee Assistance Program, PTO, and company holidays.

Equal Employment Opportunity

Moda Health is committed to equal employment opportunities regardless of race, religion, color, age, sex, sexual orientation, national origin, marital status, disability status, veteran status, or other protected classifications. Questions about accommodations can be directed to the Human Resources department via email.