Medical Claims Processor I

About Moda Health

Moda Health, established in Oregon in 1955, is built around quality service delivered by real people. The organization focuses on improving healthcare for members, supporting communities with care, and providing robust employee benefits. It also emphasizes diversity and inclusion, encouraging candidates who value and help strengthen a workplace with varied perspectives and experiences.

Role Overview

This position is responsible for handling simple to moderately complex medical claims with speed and accuracy. The work involves using internal resources effectively to enter, review, and resolve claims in line with company policies, procedures, and guidelines. This is a full-time work-from-home role.

Compensation

The hourly pay range is $17.34 to $19.41, depending on experience and qualifications. Candidates who do not meet the minimum qualifications will be considered only at the lower end of the range.

Benefits

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

Required Qualifications

A high school diploma or equivalent is required. Preferred experience includes 6 to 12 months in data entry or a medical office setting. The role also calls for strong 10-key speed, typing ability, familiarity with medical terminology, CPT, and ICD-9/10 coding, and solid communication, organization, punctuality, flexibility, and analytical thinking. Experience with the Facets platform is considered an advantage.

Primary Duties

The position includes entering claims data, interpreting codes, and applying medical terminology to diagnoses and procedures. It also involves reviewing and resolving moderately complex claims, applying plan rules such as deductibles, coinsurance, copays, and out-of-pocket limits, and directing claims to other departments when additional review is needed. The role requires meeting quality and production goals, releasing claims by required deadlines, and following policies and procedures while recommending process improvements where appropriate. Confidentiality and discretion are essential at all times.

Work Schedule and Conditions

The standard workweek is 37.5 hours. The schedule may occasionally include 5 hours of overtime on заранее scheduled Saturdays to support business needs. The job involves extensive computer and keyboard use, constant sitting, and navigating multiple screens. The role works closely with internal teams such as customer service, membership accounting, and appeals, and also supports external client needs.

Equal Opportunity and Accommodations

Moda Health provides equal employment opportunities to all qualified applicants regardless of race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status, or any other protected status. This applies to all employment terms and conditions, including hiring, placement, promotion, termination, recall, transfer, leave, compensation, and training. Questions about accommodations can be directed to Kristy Nehler or Danielle Baker via the humanresources@modahealth.com email.