Virtual Customer Service Representative [United States]

 

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.

This position provides customer service to members of multiple benefit plans by analyzing the caller’s needs and by providing timely and accurate responses. Answer calls from policyholders, agents, members, providers, and others regarding benefits, eligibility, claims, premiums, or other issues.

This position is currently full time work from home and is accepting candidates from AK, AZ, FL, ID, OR, WA. Must be able to work on PST time zone.

Position starts August 14th 2023.

Starting Salary: $18/hr

To apply please visit the link below and complete an application to be considered for this position.

• https://j.brt.mv/jb.do?reqGK=27706545&refresh=true

Benefits:

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

Schedule:

• PST
• Monday - Friday

Required Skills, Experience & Education:

High school diploma or equivalent.

Practical knowledge of medical or dental terminology preferred but not required.

Knowledge of diagnosis and procedure coding preferred but not required.

Prior customer service experience, other related experience such as medical/dental office experience, or customer support experience.

Strong reading, verbal and written communication skills. Ability to interact professionally, patiently, and courteously with customers over the phone.

Good analytical, problem solving and decision-making skills.

10-key proficiency of 105 kspm net on a computer numeric keypad.

Type a minimum of 35 wpm net on computer keyboard.

High speed internet (cable or fiber)

Must be proficient with Microsoft Office applications with the ability to open and navigate multiple windows at the same time.

Ability to achieve and maintain quality standards.

Ability to work well and independently under pressure in a complex and rapidly changing environment.

Ability to meet the attendance and punctuality policy of Moda Health.

Ability to remain focused and on task in a work from home environment.

Maintain confidentiality and project a professional business presence and appearance.

Ability to repeatedly analyze situations and communicate effectively in a fast-paced environment that includes dealing with escalating queries and concerns.

Ability to organize and remain up to date on changing and new information.

Ability to troubleshoot and follow protocols for reporting internet or technological issues.

Primary Functions:

Answer a high volume of inbound phone calls regarding dental claims, benefits, premiums, and eligibility involving employer groups, Oregon Health Plan (OHP) and Individual products. Provide solutions to problems, confirm eligibility, explain benefits and/or plan coverage.

Provide accurate information in a professional manner.

Apply mathematical skills to determine correct benefit information and premium amounts for Individual plans.

Exercise judgement, initiative, and discretion in confidential and sensitive matters.

Perform related duties: Follow HIPAA guidelines to protect member health information.
Document all aspects of a call in a clear and concise manner.
Keep up to date on new and revised benefit information, claim processing procedures, or system updates.
Gather banking details so monthly premium for members on Individual plans can be collected.
Identify and request claim adjustments when necessary.
Resolve and record complaints, appeals, and inquiries.
Contact providers, other insurance companies or state agencies when necessary to answer questions and obtain or provide information.
Provide timely follow-up and return calls within department guidelines.
Answer calls within service level time.

Perform other duties as assigned by Manager/Supervisor/Lead.

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.

Job Type: Full-time

Pay: $18.00 - $19.79 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Paid training
• Tuition reimbursement
• Vision insurance
• Work from home

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Application Question(s):

• Moda Health, Ardon, Emerging Health, and Arrow Dental can only employ candidates that are 18 years of

age or older. Are you 18 years of age or older?

• Moda Health, Ardon, Emerging Health, and Arrow Dental can only employ candidates that do NOT require

an H1B Visa Sponsorship. Do you need H1B Visa Sponsorship, or will you need one in the future?

• Moda Health, Ardon, Emerging Health, and Arrow Dental can only employ candidates that live in one of the

following States AK, AZ, FL, ID, NJ, OR, or WA.
Are you currently living full-time in one of the following States AK, AZ, FL, ID, NJ, OR, WA?
Would you be willing to relocate to one of these States?

Experience:

• Call center: 1 year (Preferred)
• Customer service: 1 year (Preferred)
• working from home: 1 year (Required)

Work Location: Remote

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