Medical Claims Clerk I

Job Description

Job Description

Let’s do great things, together!

About Moda
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.

Position Summary
The Medical Claims Clerk provides clerical and administrative support to the Medical Claims Department. The position ensures that documents, inquiries, and records are handled accurately to support consistent and compliant claim processing. This is a FT on-site position based in Milwaukie, Oregon.

Pay Range
$19.43 - $21.86 hourly (depending on experience) *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.

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Benefits:

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

Required Skills, Experience & Education:

1. 6-12 months office experience.
2. Typing ability of 30 wpm net.
3. Proficiency with Microsoft Office applications and the ability to learn internal systems including Facets and Content Manager.
4. Knowledge of or the ability to learn Moda plan benefits and claim processing guidelines.
5. Strong organizational skills and attention to detail.
6. Strong verbal, written, and interpersonal communication skills.
7. Ability to work with frequent interruptions and shifting priorities.
8. Ability to lift up to 50 lbs.
9. Ability to work onsite and maintain confidentiality.

Primary Functions:

1. Sort and distribute mail and faxes to appropriate teams and departments.
2. Scan and index mail using designated printers and software, and prepare documents for submission to Imaging according to established workflows.
3. Review provider inquiries to identify the correct plan benefits, claim processing guidelines, and required documentation needed for resolution.
4. Analyze provider types and recurring issues and identify claim processing trends and patterns. Recommend process improvements when appropriate.
5. Enter bulk provider inquiries accurately into the Moda Health operating system and ensure completeness and data integrity.
6. Manage assigned Content Manager image queues and work baskets and prioritize tasks based on urgency, service levels, and departmental guidelines.
7. Provide daily inventory counts and reporting to support workflow management and productivity monitoring.
8. Maintain organized electronic and physical records, following HIPAA requirements and internal security protocols.
9. Communicate with internal teams to clarify documentation needs, resolve discrepancies, or support claim review processes.
10. Participate in continuous improvement efforts, including updates to documentation, workflows, and training materials.
11. Perform other duties as assigned.

Working Conditions & Contact with Others

• Office environment with extensive close PC and keyboard use, constant sitting, and frequent phone communication. Must be able to navigate multiple computer screens. A reliable, high-speed, hard-wired internet connection required to support remote or hybrid work. Must be comfortable being on camera for virtual training and meetings. Work in excess of standard workweek, including evenings and occasional weekends, to meet business need.
• Internally with Claims, Imaging, Facilities and other departments as required. Externally with members, vendors, or providers as directed.
  

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. This is applicable to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absences, compensation, and training.

For more information regarding accommodations please direct your questions to Kristy Nehler and Danielle Baker via our View email address on ziprecruiter.com email.