Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, weâre 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. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Letâs be better together.
Job Summary
Provides phone, email and chat-based customer service to members of certain Performance Guarantee (PG) and Moda 360 groups by analyzing callerâs needs and providing timely and accurate responses. Answers inquiries from policyholders, members, agents, providers, hospitals, pharmacists, dentists and others regarding a wide variety of issues and questions related to a memberâs benefits and health program options. This position requires staff to be flexible with their work schedule to meet the clientâs needs. This is FT WFH role.
Pay Range
$21.30 - $23.96 hourly.
Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.
Please fill out an application on our company page, linked below, to be considered for this position:
Ability to complete training as a Customer Service Representative with the company.
Claim processing experience, prior customer service experience or other related experience such as medical/dental office or pharmacy preferred.
Practical knowledge of medical, dental and/or pharmacy terminology desired.
Knowledge of diagnosis and procedure coding helpful.
Excellent oral and written communication skills. Ability to interact professionally, patiently, and courteously with customers over the phone and in writing.
Excellent analytical, problem solving and decision-making skills.
10-key proficiency of 105 kpm net on a computer numeric keypad.
Type a minimum of 25 wpm net on computer keyboard.
Ability to work well under pressure in a complex and rapidly changing environment.
Ability to maintain excellent attendance and punctuality.
Maintain confidentiality and project a professional business presence.
Ability to work with multiple applications across multiple monitors at once and learn new applications as needed.
Experience using Microsoft Office products including Outlook, OneNote and Teams.
Experience with TriZetto Facets helpful.
Ability to learn independently and take initiative to constantly improve skills.
Though open to both internal and external candidates, internal candidates must be Fully Meeting performance expectations in their current position. Exceeding in Accuracy and Customer Service Skills is preferred.
Complete Effortless Experience training and certification after hire.
Primary Functions
Applicants will handle either medical, dental or pharmacy inquiries or a combination of two of these, depending on existing skills and training. Opportunity for promotion to Health Navigator II upon learning all three lines of business.
Answer medical, dental and/or pharmacy claim, authorization and benefit questions from customers on specific groups. Provide solutions to problems, confirm eligibility and explain benefits and plan coverage.
Handle inquiries received via phone, email, voicemail and/or online chat.
Respond to members via phone, online chat, SMS and email.
Complete detailed research and follow-up as needed. May include use of multiple resources, contact with internal departments and multiple phone calls to providers, pharmacies and other carriers to resolve a situation completely.
Work with internal departments via email, phone or meetings to resolve member issues and ensure clear communication of the memberâs needs.
Repeatedly analyze situations and communicate effectively in a fast-paced environment that includes working with f