Medical Customer Service Representative I

About Moda Health

Founded in Oregon in 1955, Moda Health is a company focused on quality healthcare coverage and fostering strong community relationships. We prioritize diversity and inclusion in our workplace and encourage candidates who value this commitment to apply.

Position Overview

This full-time remote role involves providing phone-based customer service to members across multiple health benefit plans. The key responsibilities include addressing inquiries from members, agents, providers, and others, covering topics such as benefits explanation, claims processing, and plan details.

Primary Duties

• Handle 50+ daily inbound calls regarding member claims and benefit questions for both group and individual insurance plans.
• Offer solutions, verify eligibility, confirm premiums, and collect payments for individual plans.
• Maintain professional, courteous communication even under challenging circumstances including frustrated callers.
• Use mathematical skills to accurately determine benefit information and premiums.
• Review and apply updated benefit and claim processing information.
• Explain plan authorization requirements using online tools.
• Update member primary care physician selections when necessary.
• Collect banking details for monthly premium collection on individual plans.
• Request claim adjustments as needed to correct processing errors.
• Resolve and document complaints, appeals, and inquiries.
• Assist members in locating providers that fit their plan using web-based provider search tools.
• Contact healthcare providers to obtain or share necessary information.
• Return follow-up calls promptly and document all call details clearly.
• Adhere to service level time requirements for answering calls.
• Perform additional tasks as assigned by management.

Skills and Qualifications

• High school diploma or equivalent required.
• Familiarity with medical terminology is preferred.
• Knowledge of diagnosis and procedure coding is desired.
• Experience in claim processing, customer service, or medical/dental office environment beneficial.
• Strong verbal and written communication skills; ability to handle patient and professional interactions on phone.
• Analytical thinking, problem-solving, and decision-making capabilities.
• Typing speed of at least 25 words per minute and numeric keypad proficiency of 105 strokes per minute.
• Proficiency in Microsoft Office and ability to navigate multiple windows simultaneously.
• Reliable high-speed (cable or fiber) internet connection required for remote work.
• Ability to maintain confidentiality and present a professional demeanor consistently.

Work Environment and Additional Information

• This position involves prolonged computer use and phone communication in a home office setting.
• Participation in virtual meetings and training sessions with camera engagement is expected.
• May require work beyond the standard schedule, including evenings and occasional weekends.
• Interaction internally with departments such as Medical Claims, Healthcare Services, Marketing, and externally with members, providers, brokers, and government officials.
• Moda Health is an equal opportunity employer valuing diversity and inclusivity across all employment practices.
• Employees may contact human resources for accommodation queries.

Benefits

• Medical, dental, vision, pharmacy, life, and disability insurance
• 401(k) plan with company matching
• Flexible Spending Account (FSA)
• Employee Assistance Program
• Paid time off and company holidays

Compensation

Hourly pay ranges between $18.39 and $20.58 depending on experience, with minimum qualifications qualifying for the lower end of the range.