Medical Customer Service Representative - Remote (Ak, Az, Fl, Id, Or, Wa)

Medical Customer Service Representative

• Remote (AK, AZ, FL, ID, OR, WA)

Job Title
Medical Customer Service Representative

• Remote (AK, AZ, FL, ID, OR, WA)

Duration
Open Until Filled
Work From Home
Yes
Description
Let’s do great things, together!
Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re 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. Let’s be better together.
Provides phone customer service to members of multiple benefit plans by analyzing caller’s needs and providing timely and accurate responses.
Answers calls from policyholders, members, agents, providers, hospitals, pharmacists and others regarding a variety a wide variety of issues and questions related to a members health plan. These can include explaining benefits, claims processing and other details of the plan.
This position is currently full time work from home and is accepting candidates from AK, AZ, FL, ID, OR, WA. Must be able to work on PST time zone.Position starts August 14th 2023. Starting Salary: $18/hr
Follow the link below and complete an application for this position.

• Https://j.brt.mv/jb.do?reqGK=27706543&refresh=true

Benefits

• FSA
• PTO and Company Paid Holidays
• Employee Assistance Program
• Medical, Dental, Vision, Pharmacy, Life, & Disability
• 401K- Matching

Schedule

• Friday
• PST
• Monday

Requirements

• Ability to repeatedly analyze situations and communicate effectively in a fast-paced environment that includes dealing with angry people.
• Ability to organize and remain up to date on changing and new information.
• Good analytical, problem solving and decision-making skills.
• Ability to work well under pressure in a complex and rapidly changing environment.
• High school diploma or equivalent.
• Practical knowledge of medical terminology desired.
• High speed internet (cable or fiber)
• Must be proficient with Microsoft Office applications with the ability open and navigate multiple windows at the same time.
• Claim processing experience or prior customer service experience or other related experience such as medical/dental office experience.
• 10-key proficiency of 105 spm net on a computer numeric keypad.
• Maintain confidentiality and project a professional business presence.
• Type a minimum of 25 wpm net on a computer keyboard.
• Excellent oral and written communication skills. Ability to interact professionally, patiently, and courteously with customers over the phone.
• Ability to achieve and maintain quality and quantity standards.
• Knowledge of diagnosis and procedure coding desired.
• Ability to be at work on time and daily.

Primary Functions

• Review and explain any authorization requirements of the plan using on-line tools available.
• Provide accurate information in a professional manner.
• Exercise judgement, initiative, and discretion in confidential and sensitive manners.
• Provide timely follow up and return calls when these are required.
• Ability to repeatedly analyze situations, communicate effectively, in a fast-paced environment that includes dealing with frustrated or angry callers.
• Apply mathematical skills to determine correct benefit information and premium amounts for Individual plans.
• Answers 50
• Answer calls within service level time.
• Other duties and projects as assigned by Manager/Supervisor/Lead.
• Performs related duties:
• Contact physicians, dentists, hospitals, and other providers when necessary to answer questions and obtain or provide information.
• Complete provider searches using available on-line web based systems to assist members in finding providers that meet their needs and that of that plan.
• Calls a day regarding claims and benefit questions from callers on both group and individual plans. Provide solutions to problems, confirm eligibility, verify premium’s and collect payments for members on individual plans, explain benefits and/or plan coverage.
• Update and enter primary care physician selections if required by member’s plan.
• Review, update and become familiar with new and revised benefit information or claim processing procedures.
• Request claim adjustments required because of error in processing or any new information that has been received.
• Document all aspects of a call in a clear and concise manner.
• Resolve and record complaints, appeals, and inquiries.
• Gather banking details so monthly premium for members on Individual plans can be collected.

Together, we can be more. We can be better.
Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law.For more information regarding accommodations please direct your questions to Kristy Nehler and Daniel McGinnis via our [email protected] email.
Pay Range
¤18.00
Hourly to ¤19.79
Hourly