Medical Claims Clerk I

Moda Health•Milwaukie, OR

4d•Onsite

About The Position

The Medical Claims Clerk provides clerical and administrative support to the Medical Claims Department. The position ensures that documents, inquiries, and records are handled accurately to support consistent and compliant claim processing. This is a FT on-site position based in Milwaukie, Oregon.

Requirements

6-12 months office experience.
Typing ability of 30 wpm net.
Proficiency with Microsoft Office applications and the ability to learn internal systems including Facets and Content Manager.
Knowledge of or the ability to learn Moda plan benefits and claim processing guidelines.
Strong organizational skills and attention to detail.
Strong verbal, written, and interpersonal communication skills.
Ability to work with frequent interruptions and shifting priorities.
Ability to lift up to 50 lbs.
Ability to work onsite and maintain confidentiality.

Responsibilities

Sort and distribute mail and faxes to appropriate teams and departments.
Scan and index mail using designated printers and software, and prepare documents for submission to Imaging according to established workflows.
Review provider inquiries to identify the correct plan benefits, claim processing guidelines, and required documentation needed for resolution.
Analyze provider types and recurring issues and identify claim processing trends and patterns.
Recommend process improvements when appropriate.
Enter bulk provider inquiries accurately into the Moda Health operating system and ensure completeness and data integrity.
Manage assigned Content Manager image queues and work baskets and prioritize tasks based on urgency, service levels, and departmental guidelines.
Provide daily inventory counts and reporting to support workflow management and productivity monitoring.
Maintain organized electronic and physical records, following HIPAA requirements and internal security protocols.
Communicate with internal teams to clarify documentation needs, resolve discrepancies, or support claim review processes.
Participate in continuous improvement efforts, including updates to documentation, workflows, and training materials.
Perform other duties as assigned.