Supervisor, Medical Claims

Moda Health; Portland (OR); Hybrid; USD 60,000 - 75,000; Full time

Benefits offered by this job

Medical

Dental

Vision

Pharmacy

Life Insurance

Disability Insurance

401K Matching

FSA

Employee Assistance Program

PTO and Holidays

Job summary

Moda Health in Milwaukie, Oregon, is seeking a Senior Claims Processor for a full-time hybrid role. You will supervise staff, coach and set goals, and ensure timely and accurate processing of claims.

Applicants should have 2–4 years in medical claims processing, including leadership experience, with strong communication and analytical skills. The role requires reliability, confidentiality, and a professional business image. We offer benefits, 401K, and a supportive team environment.

Qualifications

• College degree or equivalent work experience.
• 2–4 years medical claims processing experience, including 1 year as Senior/Lead processor.
• Strong verbal, written and interpersonal communication skills.
• Strong analytical, problem solving and decision-making skills.
• Ability to work well under pressure with frequent interruptions and shifting priorities.

Responsibilities

• Supervises staff giving daily work direction, vacation scheduling, monitoring attendance, conducting performance reviews, and hiring and training new employees.
• Facilitates problem solving for employees and Manager by answering claims related questions dealing with contract interpretation of benefits, procedures and claims systems.
• Controls workflow and quality by checking date and amount of work in processors queues, assigns work to ensure time service goals, tracks processors production and quality.
• Assists with planning by analyzing amount of work and type of work, assigns and sets priorities and decides on retraining needs.
• Motivates and coaches the processors by reviewing results with them, conveys to them what is expected of them, asks for suggestions, and fulfills the needs of training.
• Use and manipulate excel files.
• Other duties as assigned.

Skills

Medical claims processing experience

Communication skills

Analytical thinking

Problem solving

Ability to work under pressure

Punctuality

Professional image

Education

College degree or equivalent work experience

Tools

Microsoft Word

Microsoft Excel

Job description

About ModaFounded 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.

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

This is a FT hybrid position based in Milwaukie, Oregon. Provides supervision, coaching and support to Claims Processors. Organizes staff, sets goals, establishes procedures, and continues to ensure claims are processed promptly and accurately. Measures and evaluates performance and results. Coaches and trains as required to achieve goals of quality and efficiency.

Pay Range

$59,922.05 - $74,902.56 annually (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.

Benefits

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

Required Skills, Experience & Education

• College degree or equivalent work experience.
• 2 – 4 years medical claims processing experience, including 1 year as Senior/Lead processor.
• Computer proficiency in company’s systems and Word and Excel.
• Strong verbal, written and interpersonal communication skills.
• Strong analytical, problem solving and decision-making skills.
• Ability to work well under pressure with frequent interruptions and shifting priorities.
• Ability to come in to work on time and daily.
• Maintain confidentiality and project a professional business image.

Primary Functions

• Supervises staff giving daily work direction, vacation scheduling, monitoring attendance, conducting performance reviews, and hiring and training new employees.
• Facilitates problem solving for employees and Manager by answering claims related questions dealing with contract interpretation of benefits, procedures and claims systems.
• Controls workflow and quality by checking date and amount of work in processors queues, assigns work to ensure time service goals, tracks processors production and quality.
• Assists with planning by analyzing amount of work and type of work, assigns and sets priorities and decides on retraining needs.
• Motivates and coaches the processors by reviewing results with them, conveys to them what is expected of them, asks for suggestions, and fulfills the needs of training.
• Use and manipulate excel files.
• 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 staff, Underwriting, Professional Relation, Claims Support, Accounting, and IT. Externally with providers, policyholders, insureds, and brokers.

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 [e-mail] email.