Medical Claims Support I
WFA Digital Insight
The demand for skilled medical claims support professionals has surged in recent years, with the healthcare industry experiencing significant growth. According to recent statistics, the healthcare sector has seen a 25% increase in job openings. As a Medical Claims Support I at Moda Health, you'll play a critical role in ensuring seamless claims processing and customer service. With the rise of remote work, companies like Moda Health are seeking talented professionals who can work independently and collaboratively as part of a distributed team. Before applying, candidates should be aware of the importance of attention to detail, strong analytical skills, and excellent communication abilities in this role.
Job Description
About the Role
The Medical Claims Support I role at Moda Health is a full-time, remote position that entails investigating and processing claim adjustments for all medical lines of business and COB claim adjustments for Medicare/Medicaid plans. As a key member of the claims processing team, you will be responsible for performing COB updates, file reviews, and issuing adjustment-related letters to members and providers. Your excellent customer service skills will be essential in handling customer inquiries regarding contractual and administrative policies.The role requires a high level of attention to detail, strong analytical skills, and the ability to work efficiently in a fast-paced environment. You will be working closely with a team of professionals who are passionate about delivering exceptional customer service and ensuring seamless claims processing.
Moda Health values diversity and inclusion in the workplace, and this role is an excellent opportunity to join a company that prioritizes these values. As a remote worker, you will be expected to work independently and collaboratively as part of a distributed team.
What You Will Do
- Investigate and process claim adjustments for all medical lines of business
- Perform COB updates, file reviews, and issue adjustment-related letters to members and providers
- Handle customer service inquiries regarding contractual and administrative policies
- Assist in customer service inquiries regarding claims processing and payment issues
- Process adjustments related to overpayment recovery, underpayment adjustments, and other corrections
- Validate and complete stop payment requests
- Perform payment offsets and other financial transactions
- Collaborate with team members to resolve complex claims issues
- Maintain accurate and up-to-date records of claims processing and customer interactions
What We Are Looking For
- High school diploma or equivalent
- Minimum of 6 months of medical claim processing or customer service experience
- Excellent written and verbal communication skills
- 10-key proficiency of 135 wpm net on a computer numeric keypad
- Ability to type a minimum of 35 wpm net on a computer keyboard
- Strong analytical and problem-solving skills
- Ability to work efficiently in a fast-paced environment
- Experience with claims processing systems, such as Facets, Word, and Excel
- Knowledge of medical terminology and coding principles
Nice to Have
- Experience working in a remote or distributed team environment
- Familiarity with Moda Health administrative policies and procedures
- Certification in medical claims processing or a related field
- Bilingual or multilingual skills
Benefits and Perks
- Competitive hourly rate
- Comprehensive benefits package, including medical, dental, vision, pharmacy, life, and disability insurance
- 401(k) matching program
- Flexible spending accounts (FSA)
- Employee assistance program
- Paid time off and company-paid holidays
- Remote work stipend and equipment allowance
- Opportunities for professional development and career growth
How to Stand Out
- To stand out in your application, be sure to highlight your experience with claims processing systems, such as Facets, Word, and Excel.
- Emphasize your excellent communication skills, as customer service is a critical aspect of this role.
- Showcase your ability to work independently and collaboratively as part of a distributed team.
- Make sure to review Moda Health's administrative policies and procedures to demonstrate your knowledge and understanding of the company's values and mission.
- Prepare to discuss your experience with medical terminology and coding principles, as well as your ability to analyze and resolve complex claims issues.
- Consider including examples of your problem-solving skills and ability to work efficiently in a fast-paced environment.
- Don't hesitate to ask about the company culture and values during the interview process to ensure you're a good fit for the team.
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