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Medical Customer Service Representative

Full Time

Website Moda_Health Moda Health

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.

Currently, Moda Health is seeking a Medical Customer Service Representative.  This position will provide customer service to members of multiple benefit plans by analyzing caller’s needs and providing timely and accurate responses.  Answers calls from policyholders, members, agents, providers, hospitals, pharmacists and others regarding benefits or other issues.

Primary Functions:

  1. Answers claim benefit questions from callers on both group and individual products. Provide solutions to problems, confirm eligibility, explain benefits and/or plan coverage.
  2. Ability to repeatedly analyze situations, communicate effectively, in a fast paced environment that includes dealing with angry people.
  3. Provide accurate information in a professional manner.
  4. Apply mathematical skills to determine correct benefit information.
  5. Exercise judgement, initiative, and discretion in confidential and sensitive manners.
  6. Performs related duties:
    • Review, update and become familiar with new and revised benefit information or claim processing procedures.
    • Update and enter primary care physician selections and coordinate with Group Integration.
    • Request claim adjustments required because of error or new information. May process adjustments.
    • Resolve and record complaints, appeals, and inquiries.
    • Provide customer service to walk-in members.
    • Contact physicians, dentists, hospitals, and other providers when necessary to answer questions and obtain or provide information.
    • Provide timely follow up and return calls when these are required.
    • Answer calls within service level time.
  7. Other duties as assigned

Are you ready to be a betterist?

If you’re ready to make a difference that matters, we want to hear from you. Because it’s time to discover what’s possible.

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.

***All Bend applicants must go to WorkSource Bend, to complete the 10-key and typing assessments prior to applying for the position.***

Required Skills

  1. High school diploma or equivalent.
  2. Practical knowledge of medical terminology desired.
  3. Knowledge of diagnosis and procedure coding desired.
  4. Claim processing experience or prior customer service experience or other related experience such as medical/dental office experience.
  5. Excellent oral and written communication skills. Ability to interact professionally, patiently, and courteously with customers over the phone and in person.
  6. Good analytical, problem solving and decision-making skills.
  7. 10-key proficiency of 105 spm net on a computer numeric keypad.
  8. Type a minimum of 25 wpm net on a computer keyboard.
  9. Ability to work well under pressure in a complex and rapidly changing environment.
  10. Ability to come into work on time and on a daily basis.
  11. Maintain confidentiality and project a professional business presence and appearance

To apply for this job please visit

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