Contract Specialist I

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
Subject matter expert regarding health plan contracts; preparation of a high volume of medical and dental plan documents for standard and non-standard groups in compliance with company specifications, turnaround time requirements and all state and federal laws and regulations; production of Summary of Benefit and Coverage and Plan Change Form documents.

This is a FT WFH role.

Pay Range
$23.34 - $26.26 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.

Benefits :

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

Required Skills, Experience & Education:

1. Bachelor’s degree or combination of college level coursework and relevant experience.
2. 1-2 years of insurance experience preferred in areas such as Claims and/or Customer Service.
3. Demonstrated proficiency using Adobe and Microsoft Office applications, including Word and Excel.
4. Proficiency in computer keyboard; minimum typing ability of 35 wpm.
5. Effective verbal, written and interpersonal communications skills.
6. Demonstrated ability to identify problems and initiate a solution.
7. Ability to initiate and follow departmental policies and procedures.
8. Ability to work under pressure and exhibit flexibility in changing priorities.
9. Ability to learn new information and apply it to a variety of situations.
10. Highly effective organizational skills with the ability to prioritize and meet deadlines.
11. Maintain confidentiality and project a professional business image to internal and external customers.
12. Ability to come to work on time and on a daily basis.

Primary Functions :

1. Analyze and comprehend source documents such as Group Application, identify potential errors, research as appropriate and correct any incorrect information.
2. Accurately prepare plan documents for new and renewing standard and non-standard groups.
3. Learn and understand company products, including annual changes and new products, and how they relate to plan documents.
4. Learn and understand the difference in standard and non-standard language.
5. Function as subject matter expert and respond to inquiries from internal departments regarding plan documents.
6. Identify discrepancies between source documents and contract department records and articulate questions to relevant internal departments.
7. Communicate with internal departments on requested changes to plan documents
8. Develop a chronology of actions taken and maintain group files and work logs accordingly.
9. Assist in development of policies and procedures.
10. Produce Summary of Benefit and Coverage (SBC) and Plan Change Form documents.
11. Perform peer-audits and self-audits of plan documents for accuracy.
12. Produce a quality product under short turnaround time requirements, in accordance with department productivity and accuracy standards.
13. Support peers in a team structure.
14. Train lower-level staff, such as temporary staff.
15. 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 Sales and Account Services, Regulatory, Claims, Business Implementation Unit, Benefit Configuration, Membership Accounting, Pharmacy, Underwriting, and Contract Services.

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.