Remote COB Medical Claims Processor I

Moda Partners, Inc.; Oregon; Hybrid; USD 25,000 - 28,000; Full time

Benefits offered by this job

Medical, Dental, Vision, Pharmacy,Life

401K- Matching

FSA

Employee Assistance Program

PTO and Company Paid Holidays

Job summary

Moda Health in Oregon seeks a COB Claims Processor to investigate and process Coordination of Benefits (COB) claims and respond to customer inquiries with excellent service.

This full-time work-from-home position requires attention to detail, accuracy, and proficiency with Facets, Microsoft Word and Excel. Eligible employees receive comprehensive benefits, PTO, and a competitive 401(k) plan.

Qualifications

• High School diploma or equivalent.
• Minimum of 6 months medical claim processing or customer service experience.
• Professional and effective written and verbal communication skills.
• 10-key proficiency of 135 spm on a computer numeric keypad.
• Type a minimum of 35 wpm net on a computer keyboard.
• Maintain balanced performance in production and quality.
• Good analytical, problem solving, decision making and detail-oriented skills.
• Proficiency in claims processing systems; Facets, Word, and Excel.
• Knowledge of Moda Health administrative policies affecting claims and customer service.
• Demonstrates attendance, punctuality, and flexibility.

Responsibilities

• Communicates via telephone with claimants, policyholders, providers, and other insurance carriers.
• Review, analyze, and resolve claims using available resources for complex cases.
• Apply plan concepts to claims including deductible, coinsurance, copay, COB, and out-of-pocket.
• Route claims for further investigation within the system as needed.
• Release claims by deadline to meet regulations and group standards.
• Maintain confidentiality in line with guidelines.
• Document actions per internal procedures and market conduct guidelines.
• Assist internal departments with eligibility and programming issues as needed.
• Respond and follow up using FACETS, Content Manager and E-mail.
• Provide backup to Medical Claims when requested.

Skills

Medical claim processing

Customer service

Communication

10-key proficiency

Typing 35 wpm

Attention to detail

Analytical skills

Confidentiality

Multitasking

Adaptability

Education

High School diploma or equivalent

Tools

Facets

Word

Excel

Job description

Moda Health in Oregon seeks a COB Claims Processor to investigate and process Coordination of Benefits (COB) claims and respond to customer inquiries with excellent service.

This full-time work-from-home position requires attention to detail, accuracy, and proficiency with Facets, Microsoft Word and Excel. Eligible employees receive comprehensive benefits, PTO, and a competitive 401(k) plan.