Medicare Customer Service Representative

Customer Service Representative, Medicaid – Work from Home for residents or candidates willing to relocate to the following States; AK, ID, OR or WA

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.

Provides customer service to members of Medicare and PERS 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 benefits or other issues. This position requires open availability 7am-8pm, 7 days a week.

This position starts on May 8th 2023.

To apply to this position please follow the link below and complete an application.

• Https://j.brt.mv/ATS/jb.do?reqGK=27698963&refresh=true

Benefits:

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

Schedule:

• PST

Required Skills, Experience & Education:

• 10-key proficiency of 105 spm net on a computer numeric keypad.
• Claim processing experience or prior customer service experience or other related experience such as medical/dental office or pharmacy experience.
• Type a minimum of 25 wpm net on computer keyboard.
• High school diploma or equivalent.
• Maintain confidentiality and project a professional business presence and appearance.
• Ability to work with multiple Pharmacy and Medical applications.
• Ability to come to work on time and daily.
• Knowledge of the diagnosis and procedure coding desired.
• Empathy/passion for working with senior, disabled, low-income populations
• Ability to work well under pressure in a complex and rapidly changing environment.
• Excellent oral and written communication skills. Ability to interact professionally, patiently, and courteously with customers over the phone and in person.
• Good analytical, problem solving and decision-making skills.
• Practical knowledge of medical and/or pharmacy terminology desired.

Primary Functions:

• Answers pharmacy and medical claim benefit questions from callers on Medicare products. Provide solutions to problems, confirm eligibility, explain benefits and/or plan coverage, and prescription drug benefits.
• Apply the Annual Notice of Change and Evidence of Coverage guidelines consistently.
• Exercise judgment, initiative, and discretion in confidential and sensitive matters.
• Ability to repeatedly analyze situations, communicate effectively, in a fast-paced environment that includes dealing with angry people.
• Provide accurate information in a professional manner.
• Performs related duties:Review, update and become familiar with new and revised benefit information or claim processing procedures.
• Apply mathematical skills to determine correct benefit information.

Review and become familiar with changes in Medicare formularies and prescription benefits.
Accurately apply CMS Grievance, Appeals and Coverage Determination processes.
Update and enter primary care physician selections.
Request claim adjustments required because of error or new information.
Resolve and record complaints, appeals, and grievances for Medical and Pharmacy within Medicare guidelines.
Provide customer service to walk-in members.
Contact physicians, dentists, hospitals, pharmacies, and other providers when necessary to answer questions and obtain or provide information.
Provide timely follow up and return calls when these are required.
Answers calls within CMS service level guidelines.
Finalize member issues within Medicare turn-around-time guidelines.
Answer callers’ Medicare Part A, B, C and D questions accurately and within CMS time frames.

• Perform other duties and responsibilities as assigned.

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

Job Type: Full-time

Pay: $18.00 - $19.79 per hour

Benefits:

• Flexible spending account

Schedule:

• Monday to Friday
• 8 hour shift

Experience:

• Call center: 1 year (Required)
• Customer service: 1 year (Preferred)

Work Location: Remote