Job type full-time
Full job description
Customer service representative, medicaid – work from home
Let’s do great things, together.
Founded in oregon in 1955, moda is proud to be a company of real people committed to qualityToday, like then, we’re focused on building a better future for healthcareThat starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employeesIt keeps going by connecting with neighbors to create healthy spaces and places, together.
Moda values diversity and inclusion in our workplaceWe aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversityOur diverse experiences and perspectives help us become a stronger organizationLet’s be better together.
Provide excellent customer service primarily by telephone to medicaid plan members and providers by analyzing caller`s needs and providing accurate and timely responsesAssist callers with benefits, claims, and prior authorization related questionsConduct prompt and thorough research and follow-up for swift resolution of caller issuesThis position requires open availability 7:30am-5:30pm, monday – friday.
This position is currently full time work from home and is accepting candidates from ak, az, id, or, tx, wa.
Position starts january 31, 2022.
Work efficiently in a high volume call center (work from home) setting, repeatedly analyzing situations, utilizing/navigating multiple computer systems simultaneously, while communicating effectively using strong customer service and conflict resolutions skills in a fast paced environment.
Answer plan benefit questions from callers on medicaid medical and pharmacy productsProvide solutions to problems and determine an individualized path to resolution by keeping resources up to date and organized, providing information on community resources when appropriate.
Maintain confidentiality of information for all members by adhering to moda privacy policies and hipaa laws and guidelinesExercise judgment, initiative, and discretion in confidential and sensitive matters.
Provide accurate information in a professional manner using current technology and software to document calls from members, providers and other customers in a clear and concise manner.
Work collaboratively and relay information to appropriate internal and external departments and partners using approved company channels and proceduresPerform outreach to physicians, hospitals, pharmacies and other providers when necessary to answer questions and obtain or provide information.
Performs related duties:
Review, update and become familiar with new and revised benefits, policy information, and/or claim processing procedures.
Meet department standards and expectations including but not limited to quality, production, and attendance.
Perform other related duties as assigned.
Work experience: one year medical insurance, other healthcare related field, call center, or customer service experience required.
Education, certificates, licenses: high school diploma or equivalent required.
Preferred knowledge: understand insurance and medical terminologyProficient computer skills, typing, and 10-key required.
Are you ready to be a betterist?
If you’re ready to make a difference that matters, we want to hear from youBecause it’s time to discover what’s possible.
Together, we can be moreWe 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
01High school diploma or equivalent02Minimum of one year of experience working in customer service is required, preferably in health care or a health plan customer service call center, or work experience and/or training that would likely provide the ability to perform the essential functions of the position03Practical knowledge of medical and/or pharmacy terminology desired04Knowledge of diagnosis and procedure coding desired05Claim processing experience or prior customer service experience or other related experience such as medical/dental office or pharmacy experience 06Excellent oral and written communication skills07Ability to interact professionally, patiently, and courteously with customers over the phone and in person08Ability to articulate complex information in an easy to understand manner09Strong active listening skills and the ability to ask probing questions and understand concerns 10Ability to work effectively with a team, and exercise sound judgment in handling assigned tasks including maintenance of strict confidentiality 11Excellent interpersonal, written and oral communication skills 12Ability to demonstrate cooperation and teamwork13Good analytical and problem solving skills14Type a minimum of 25 wpm net on computer keyboard15Ability to work well under pressure in a complex and rapidly changing environment16Ability to maintain agreed upon work schedule17Maintain confidentiality and project a professional business presence and appearance18Empathy/passion for working with disabled and low income populations 19Ability to work with multiple pharmacy and medical applications.