Customer Service Representative--Coordinated Care (CCO)-Remote (AK,AZ,ID,OR,TX,WA) - #740253

Moda Health


Date: 01/14/2022 13:30 PM

City: Washington, Texas

Contract type: Full Time

Work schedule: Full Day

Customer Service Representative, Medicaid – Work from Home


Let’s do great things, together.


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 Overview:

Provide excellent customer service primarily by telephone to Medicaid plan members and providers by analyzing caller's needs and providing accurate and timely responses. Assist callers with benefits, claims, and prior authorization related questions. Conduct prompt and thorough research and follow-up for swift resolution of caller issues. This position requires open availability 7:30am-5:30pm, Monday – Friday.



This position is currently full time work from home and is accepting candidates from AK, AZ, ID, OR, TX, WA.



Position starts January 31, 2022.


Primary Functions:


  • Work efficiently in a high volume call center (work from home) setting, repeatedly analyzing situations, utilizing/navigating multiple computer systems simultaneously, while communicating effectively using strong customer service and conflict resolutions skills in a fast paced environment.
  • Answer plan benefit questions from callers on Medicaid medical and pharmacy products. Provide solutions to problems and determine an individualized path to resolution by keeping resources up to date and organized, providing information on community resources when appropriate.
  • Maintain confidentiality of information for all members by adhering to Moda privacy policies and HIPAA laws and guidelines. Exercise judgment, initiative, and discretion in confidential and sensitive matters.
  • Provide accurate information in a professional manner using current technology and software to document calls from members, providers and other customers in a clear and concise manner.
  • Work collaboratively and relay information to appropriate internal and external departments and partners using approved company channels and procedures. Perform outreach to physicians, hospitals, pharmacies and other providers when necessary to answer questions and obtain or provide information.

Performs related duties:


  • Review, update and become familiar with new and revised benefits, policy information, and/or claim processing procedures.
  • Meet department standards and expectations including but not limited to quality, production, and attendance.
  • Perform other related duties as assigned.

Work Experience: One year medical insurance, other healthcare related field, call center, or customer service experience required.


Education, Certificates, Licenses: High School Diploma or equivalent required.


Preferred Knowledge: Understand insurance and medical terminology. Proficient computer skills, typing, and 10-key required.





Are you ready to be a betterist?


If you’re ready to make a difference that matters, we want to hear from you. Because it’s time to discover what’s possible.


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




01. High school diploma or equivalent
02. Minimum of one year of experience working in customer service is required, preferably in health care or a health plan customer service call center, OR work experience and/or training that would likely provide the ability to perform the essential functions of the position
03. Practical knowledge of medical and/or pharmacy terminology desired
04. Knowledge of diagnosis and procedure coding desired
05. Claim processing experience or prior customer service experience or other related experience such as medical/dental office or pharmacy experience
06. Excellent oral and written communication skills.
07. Ability to interact professionally, patiently, and courteously with customers over the phone and in person
08. Ability to articulate complex information in an easy to understand manner
09. Strong active listening skills and the ability to ask probing questions and understand concerns
10. Ability to work effectively with a team, and exercise sound judgment in handling assigned tasks including maintenance of strict confidentiality
11. Excellent interpersonal, written and oral communication skills
12. Ability to demonstrate cooperation and teamwork
13. Good analytical and problem solving skills
14. Type a minimum of 25 wpm net on computer keyboard
15. Ability to work well under pressure in a complex and rapidly changing environment.
16. Ability to maintain agreed upon work schedule
17. Maintain confidentiality and project a professional business presence and appearance
18. Empathy/passion for working with disabled and low income populations
19. Ability to work with multiple Pharmacy and Medical applications.

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