Medical Claims Operations Assistant

Lets 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 were 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. Lets be better together.

Position Summary
As a Medical Claims Operations Assistant you will support the daily operations that help Moda deliver timely and accurate claims services. Responsibilities include organizing incoming mail preparing documents for imaging updating tracking tools and assisting with departmental correspondence and administrative tasks. This position is ideal for someone who enjoys detail-focused work and takes pride in supporting reliable processes that benefit our members and providers. Additional responsibilities include ordering and maintaining supplies ensuring the supply room is organized and assisting with special projects as needed. This is a fully on-site position based in Milwaukie Oregon.


Pay Range
$17.00 - $18.55 hourly DOE.
*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.

Please fill out an application on our company page linked below to be considered for this position.
Dental Vision Pharmacy Life & Disability

Required Skills Experience & Education:

1. High school diploma or equivalent.
2. At least 6-12months experience in a production environment is preferred.
3. Ability to lift 50 pounds and work in a fast-pacedphysical role.
4. Ability to embrace process improvements and work well in a team-oriented environment.
5. Strong proficiencywith Microsoft Office applications.
6. Typing ability of 35 wpm.
7. 10-keyproficiencyof 135kspm.
8. Strong organizational skills and attention to detail.
9. Proficient with prioritizing tasks and completing them with high accuracy and speed.
10. Ability to work well under pressurewith frequent interruptions and shifting priorities.
11. Demonstrates effective readingwritingand oral communication skills.
12. Ability to meet production and quality standards forvarious typesof work and documents.
13. Skilled in handling multiple tasks.

Primary Functions:

1. Handle all incoming mail including inter-office packages letters claims and certified and index incoming mail at the printer or compile documents to send to Imaging.
2. Receive and send facsimile submissions and distribute accordingly.
3. Work assigned imaging application queues.
4. Write and mail letters to members and providers.
5. Examine claims to determine if further investigation is needed from the Hospital Audit department request itemizations of services from providers mail outgoing letters and route claims appropriately through the claims processing system.
6. Manage and update multiple tracking spreadsheets for claim audits and follow-up tasks.
7. Processes voided checks. Issues follow up correspondence letters as needed.
8. Communicate via telephone with providers and facilities.
9. Responds and follows up using Facets Content Manager E-mail and Teams.
10. Responsible for ordering maintaining supplies and ensuring supply room is properly stocked and organized.
11. Provide assistance to Medical Claims department as needed for special projects.
12. 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 and system applications simultaneously. Inside the company with own claims department staff Imaging Department Facilities and other as required.
• Internally with Claims Customer Service Healthcare Services Membership Accounting Information Technology and Professional Relations. Externally with Providers/Facilities Vendors and Insurance companies. Primary communications will be with the team of RN Hospital Auditors.

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 Danielle Baker & Kristy Nehler via our email.