Medical Claims COB Processor I

Moda Health•Milwaukie, OR

7d•Remote

About The Position

Moda Health is seeking a Medical Claims COB Processor I to investigate and process COB (Coordination of Benefits) claims. This role involves completing all necessary steps for claims processing and assisting with customer service inquiries regarding contractual and administrative policies. The position requires excellent customer service skills, especially when phone calls are needed to complete a COB claim. This is a full-time, work-from-home role with a pay range of $18.39 - $20.58 hourly, depending on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range. To be considered, please fill out an application on the company page.

Requirements

High School diploma or equivalent.
Minimum of 6 months medical claim processing or customer service dealing with all types of plans/claims and consistently exceeding performance levels.
Professional and effective written and verbal communication skills.
10-key proficiency of 135 spm net on a computer numeric keypad.
Type a minimum of 35 wpm net on a computer keyboard.
Ability to maintain balanced performance, which consistently exceeds minimum expectations in areas of production and quality.
Good analytical, problem solving, decision making and detail-oriented skills with ability to shift priorities as needed.
Good organizational abilities and the ability to handle a variety of functions.
Ability to multitask and work well under pressure and meet timelines.
Ability to maintain confidentiality internally and externally and project a professional business image always.
Proficiency in claims processing systems; Facets, Word, and Excel.
Knowledge and understanding of Moda Health administrative policies affecting claims and customer service.
Demonstrates work habits that include Moda Health standards of attendance and punctuality, as well as flexibility.
Must be able to navigate multiple screens.
Be able to work extra hours during the work week and occasional Saturdays to meet business needs.
Office environment with extensive close PC and keyboard work, constant sitting, and phone work.
Must be able to navigate multiple screens.
Work in excess of 37.5 hours per week, including evenings and occasional weekends, to meet business need.

Nice To Haves

Works internally with the customer service, membership accounting, and appeals departments.
Works externally to support client needs.

Responsibilities

Communicates via telephone with claimants, policyholders, providers, and other insurance carriers.
Review, analyze, and resolve claims through the utilization of available resources for complex claims.
Analyze and apply plan concepts to claims that include deductible, coinsurance, copay, COB, and out of pocket, etc.
Examines claims to determine if further investigation is needed from other departments and routes claims appropriately through the system.
Release claims by deadline to meet Company, state regulations, contractual agreements, and group performance guarantee standards.
Maintain discretion and confidentiality in compliance with federal, state, and departmental guidelines.
Reviews Policy and Procedures (P&P) for process instructions to ensure accurate and efficient claims processing as well as providing suggestions for potential process improvements.
Monitors and maintains unit inventory.
Thoroughly documents actions as required by internal procedure and market conduct guidelines.
Assists internal departments with correcting eligibility and programming issues as needed.
Responds and follows up using FACETS, Content Manager and E-mail.
Provides back up to Medical Claims when requested.
Performs all job functions with a high degree of discretion and confidentiality in compliance with federal, state, and departmental confidentiality guidelines.
Perform other duties as assigned.
Work weekly Itinerary reports
Ability to maintain balanced performance, which consistently exceeds expectations in areas of production and quality.
Work on other new COB related functions as needed.
Copy Dual Moda claims
Work Vision COB claims
Review and submit Overpayment spreadsheet
Complete updates
Process Medicare COB claims
Adjust COB claims
Work Clinical Edit (CE) COB claims as needed
Identify and route claims requiring further investigation within the system.