Medical Claims Processor I

Medical Claims Processor I

Company: Moda Health Location: Remote Job Type: Permanent, Full-Time Salary: $17.34 - $19.41 hourly (DOE)

Moda Health, founded in Oregon in 1955, is dedicated to building a better future for healthcare. We are committed to providing outstanding coverage to our members, compassionate support to our community, and comprehensive benefits to our employees. We value diversity and inclusion in our workplace and invite applications from candidates who share this commitment.

About the Role

As a Medical Claims Processor I, you will be responsible for the accurate and timely entry, review, and resolution of simple to moderately complex medical claims. This is a full-time, work-from-home position where you will utilize company resources efficiently in accordance with established policies, procedures, and guidelines.

Key Responsibilities

• Enter claims data into the system, interpreting coding and understanding medical terminology related to diagnoses and procedures.
• Review, analyze, and resolve claims using available resources.
• Apply plan concepts to claims, including deductible, coinsurance, copay, and out-of-pocket expenses.
• Examine claims to determine if further investigation is needed and route them to the appropriate departments.
• Adjudicate claims to meet quality and production standards.
• Release claims by deadlines to comply with company, state regulations, contractual agreements, and performance guarantees.
• Review Policies and Procedures for accurate and efficient claims processing and suggest potential process improvements.
• Perform all job functions with a high degree of discretion and confidentiality, adhering to federal, state, and departmental guidelines.

Requirements

• High School diploma or equivalent.
• 6-12 months of data entry or medical office experience preferred.
• 10-key proficiency of 135 strokes per minute.
• Typing speed of at least 35 words per minute.
• Knowledge of medical terminology, CPT codes, and ICD-9/10 codes preferred.
• Demonstrated work habits including punctuality, organization, and flexibility.
• Ability to maintain balanced performance in production and quality.
• Analytical reasoning and flexibility.
• Professional and effective written and verbal communication skills.
• Experience with the Facets platform is a plus.

What We Offer

• Medical, Dental, Vision, Pharmacy, Life, & Disability insurance.
• 401K with matching contributions.
• Flexible Spending Account (FSA).
• Employee Assistance Program.
• Paid Time Off (PTO) and Company Paid Holidays.
• A standard 37.5-hour work week, with potential for up to 5 hours of overtime on pre-determined Saturdays to meet business needs.