Membership Acct Qual Analyst (27784595)

Insperity; Portland, Northern (OR, KY); Hybrid; USD 32,000 - 36,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Pharmacy benefits

Life Insurance

Disability insurance

401K matching

FSA

Employee Assistance Program

Paid holidays & PTO

Job summary

Moda Health, a health insurance provider based in Portland, Oregon, is seeking a Quality Assurance Auditor to verify enrollment, billing, and reconciliation across Membership Accounting. The role involves auditing, reporting, and driving quality improvements in a collaborative, hybrid work setting.

Applicants should have a HS diploma and 1–2 years in health insurance QA, with strong communication and analytical skills.

Qualifications

• High School diploma or equivalent required.
• 1–2 years quality review experience in a health insurance environment.
• Strong interpersonal skills and ability to work as part of a team.
• Proficient with Word, Excel, and navigating web-based systems.
• Excellent written and verbal communication; professional demeanor.
• Strong analytical, problem-solving, and organizational skills.
• Punctuality and reliability in attendance.
• Maintain confidentiality and professional appearance.

Responsibilities

• Audit enrollments, billings and reconciliation daily using statistically valid sampling; perform simple adjustments as needed.
• Ensure departmental QA standards and regulatory adherence through audits of duties.
• Conduct in-depth enrollment, billing and reconciliation audits for performance groups on a scheduled basis.
• Prepare monthly/quarterly reports for group performance, production and accuracy results.
• Identify trends from audits and recommend quality improvements.
• Create/update documentation, procedures, and resource materials.
• Support quality initiatives and foster teamwork; maintain a positive attitude.
• Perform additional duties as assigned.

Skills

Quality review

Health insurance domain

Interpersonal skills

Analytical thinking

Education

High school diploma

Tools

Word

Excel

Web-based systems

Job 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.

This is a full-time hybrid role based in Portland, Oregon. Provide accurate quality assurance auditing of pre and post enrollment, billing and reconciliation functions as performed by Membership Accounting specialists of all levels. Track and report on quality trending as it relates to specific specialists as well as department level production.

Pay Range $23.34 - $26.26 hourly, DOE. *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.

Benefits:

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

Required Skills, Experience, & Education:

1. High School diploma or equivalent required.
2. 1-2 years quality review experience in a health insurance environment, preferably in a Membership Accounting (enrollment, billing & reconciliation) department preferred.
3. Demonstrate strong, effective, and diplomatic interpersonal skills with employees of all levels and participate effectively as a team player.
4. Knowledge of Word, Excel, and ability to navigate web-based programs.
5. Excellent reading, verbal, and written communication skills, and the ability to interact professionally, patiently, and courteously with others.
6. Good analytical, problem solving, decision making and organizational, and detail-oriented skills with ability to shift priorities.
7. Ability to come in to work on time and on a daily basis.Maintain attendance above company standards.
8. Maintain confidentiality and project a professional business presence and appearance.

Primary Functions:

1. Audit enrollments, billings and reconciliation daily using statistically valid sampling methodology, using prescribed audit criteria.Performs simple adjustments as necessary.
2. Ensures departmental quality assurance standards, employer group Statement of Work, and State and Federal Regulations are adhered to through auditing all Membership Accounting Specialist duties.
3. Conduct in-depth enrollment, billing, and reconciliation on performance groups, as well as focused audits for specifically identified situations or specialists on a scheduled basis.
4. Prepares required monthly and/or quarterly reports for specific group performance guarantees, production, and accuracy results.
5. Identify trends from audit results and recommend improvements to increase overall quality.
6. Creates and updates documentation, department procedures, and resource materials as needed.
7. Responsible for quality and continuous improvement within job scope.
8. Contributes to and supports the company’s quality initiatives by encouraging team and individual contributions toward the company’s quality improvement efforts.
9. Fosters and atmosphere of team spirit and portrays an outgoing and positive attitude with peers, Moda and BHS Leadership, Customers, trainees, and Specialists.
10. Responsible for regularly scheduled operational audits of staff members for your respective team and product line.
11. 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 Membership Accounting Leadership Team, Sales and Account Services, Customer Service, Business Implementation Unit (BIU), Accounting, IS, and Medicare Operations. Externally with Clients and Customers.

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 & Danielle Baker via our [e-mail] email.