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Medical Claims Processor

Full Time

Website 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.

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.​​

We are currently seeking a Medical Claims Processor. This role is responsible for utilizing resources efficiently for the accurate and timely entry, review, and resolution of simple to moderate complexity medical claims in accordance with policies, procedures, and guidelines as outlined by the company.

Training Class starts; November 09, 2020; Work from home position!

Primary Functions:

  1. Enters claims data into system while interpreting coding and understanding medical terminology in relation to diagnosis and procedures.
  2. Review, analyze, and resolve claims through the utilization of available resources for moderately complex claims.
  3. Analyze and apply plan concepts to claims that include; deductible, coinsurance, copay, out of pocket, etc.
  4. Examines claims to determine if further investigation is needed from other departments and routes claims appropriately through the system.
  5. Adjudication of claims to achieve quality and production standards applicable to this position.
  6. Release claims by deadline to meet company, state regulations, contractual agreements and group performance guarantee standards.
  7. Reviews User Procedure Manuals (UPMs) for process instructions to ensure accurate and efficient claims processing as well as providing suggestions for potential process improvements.
  8. Performs all job functions with a high degree of discretion and confidentiality in compliance with federal, state and departmental confidentiality guidelines.

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.

Required Skills

  • High School diploma or equivalent
  • 6-12 months data entry or medical office experience preferred
  • 10-key proficiency of 135 spm
  • Type a minimum of 35 wpm
  • Knowledge of medical terminology, CPT codes and ICD-10 codes preferred
  • Demonstrates work habits that include punctuality, organization, and flexibility
  • Ability to maintain balanced performance in areas of production and quality
  • Analytical reasoning and flexibility
  • Professional and effective written and verbal communication skills
  • Experience with Facets platform a plus

To apply for this job please visit

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