Demo

Medical Claims Processor I

Moda Health
Moda Health Salary
Milwaukie, OR Full Time
POSTED ON 3/27/2025
AVAILABLE BEFORE 5/27/2025

Let’s 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, 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.


Position Summary

Responsible for utilizing resources efficiently for the accurate and timely entry, review, and resolution of simple to moderately complex medical claims in accordance with policies, procedures, and guidelines as outlined by the company. This is a fully remote position.



Pay Range
$17.00 - $19.03 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.

https://j.brt.mv/jb.do?reqGK=27752656&refresh=true

Benefits:

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


Required Skills, Experience & Education:

  • 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-9/10 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
  • Identify all the duties and responsibilities


Primary Functions
:

  • Enters claims data into system while interpreting coding and understanding medical terminology in relation to diagnosis and procedures.
  • Review, analyze, and resolve claims through the utilization of available resources for moderately complex claims.
  • Analyze and apply plan concepts to claims that include deductible, coinsurance, copay, out of pocket, etc.
  • Examines claims to determine if further investigation is needed from other departments and routes claims appropriately through the system.
  • Adjudication of claims to achieve quality and production standards applicable to this position.
  • Release claims by deadline to meet company, state regulations, contractual agreements, and group performance guarantee standards.
  • Reviews Policies and Procedures (P&P’S) for process instructions to ensure accurate and efficient claims processing as well as providing suggestions for potential process improvements.
  • Performs all job functions with a high degree of discretion and confidentiality in compliance with federal, state, and departmental confidentiality guidelines.
  • Flexible schedule that may include working 5 hours of overtime on pre-determined Saturdays to meet business needs. Moda’s standard workweek is a 37.5 hour work week.

Working Conditions & Contact with Others:
  • Office environment with extensive close PC and keyboard work with constant sitting. Must be able to navigate multiple screens. Flexible schedule that may include working 5 hours of overtime on pre-determined Saturdays to meet business needs. Moda’s standard workweek is a 37.5 hour work week.
  • Works internally with the customer service, membership accounting, and appeals departments. Works externally to support client needs.

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 Kristy Nehler via our humanresources@modahealth.com email.

Salary : $17 - $19

If your compensation planning software is too rigid to deploy winning incentive strategies, it’s time to find an adaptable solution. Compensation Planning
Enhance your organization's compensation strategy with salary data sets that HR and team managers can use to pay your staff right. Surveys & Data Sets

What is the career path for a Medical Claims Processor I?

Sign up to receive alerts about other jobs on the Medical Claims Processor I career path by checking the boxes next to the positions that interest you.
Income Estimation: 
$38,612 - $46,691
Income Estimation: 
$48,731 - $60,363
Income Estimation: 
$43,963 - $55,591
Income Estimation: 
$44,557 - $53,909
Income Estimation: 
$87,788 - $104,837
Income Estimation: 
$70,647 - $86,374
Income Estimation: 
$123,613 - $165,638
Income Estimation: 
$69,116 - $84,792
Income Estimation: 
$55,490 - $70,607
Income Estimation: 
$70,647 - $86,374
Income Estimation: 
$123,613 - $165,638
Income Estimation: 
$69,116 - $84,792
Income Estimation: 
$37,439 - $47,369
Income Estimation: 
$48,731 - $60,363
Income Estimation: 
$43,963 - $55,591
Income Estimation: 
$44,557 - $53,909
Income Estimation: 
$48,731 - $60,363
Income Estimation: 
$55,490 - $70,607
Income Estimation: 
$49,313 - $64,855
Income Estimation: 
$49,126 - $60,591

Sign up to receive alerts about other jobs with skills like those required for the Medical Claims Processor I.

Click the checkbox next to the jobs that you are interested in.

  • Claim Investigation Skill

    • Income Estimation: $68,021 - $91,814
    • Income Estimation: $73,591 - $100,276
  • Customer Support Skill

    • Income Estimation: $64,935 - $90,225
    • Income Estimation: $68,572 - $88,426
View Core, Job Family, and Industry Job Skills and Competency Data for more than 15,000 Job Titles Skills Library

Job openings at Moda Health

Moda Health
Hired Organization Address Portland, OR Full Time
Let’s do great things, together! About Moda Founded in Oregon in 1955, Moda is proud to be a company of real people comm...
Moda Health
Hired Organization Address Portland, OR Temporary
Let’s do great things, together! About Moda Founded in Oregon in 1955, Moda is proud to be a company of real people comm...
Moda Health
Hired Organization Address Portland, OR Temporary
Let’s do great things, together! About Moda Founded in Oregon in 1955, Moda is proud to be a company of real people comm...
Moda Health
Hired Organization Address Medford, OR Part Time
As we grow our service area in the Pacific Northwest, we are seeking a Part-time Home Infusion Nurse join our team of ex...

Not the job you're looking for? Here are some other Medical Claims Processor I jobs in the Milwaukie, OR area that may be a better fit.

Medical Claims COB Processor I

Moda Health, Remote in Milwaukie, OR

Medical Claims COB Processor I

Moda Health, Milwaukie, OR

AI Assistant is available now!

Feel free to start your new journey!