Quality Audit Specialist - Internal

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.

The Customer Service Quality Specialist I plays a vital role in enhancing customer service interactions by evaluating performance and fostering team collaboration to uphold service standards. This position is essential in driving customer satisfaction and improving team effectiveness across all Moda and Delta Dental Customer Service teams. To ensure high‑quality interactions, the Specialist reviews a variety of communications, including call recordings, voicemails, emails, and chat transcripts, generated by Customer Service Representatives, Technical Support Specialists, third‑party vendors, department leaders, and trainees.

Constructive feedback is systematically provided to ensure quality assurance across all contact channels. Additionally, ongoing training is offered as needed to continuously improve service delivery and enhance customer experience. This is a full‑time hybrid position based in Milwaukie, Oregon.

$21.30 - $23.96 hourly (depending on experience). 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.

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

• High School diploma or equivalent.
• Minimum of 6 months of experience in Customer Service or Call Center roles, preferably within healthcare. Experience should include handling escalated interactions via phone, email, or chat, and resolving complex issues.
• Minimum of 10‑key proficiency of 130 kpm and a minimum of typing proficiency of 50 wpm.
• Proficiency with Microsoft Office, Moda operating systems, and NICE software.
• Knowledge of one Customer Service‑related department (e.g., Medical, Pharmacy, Dental, CS Tech Support, BHS, OHP, and EOCCO) with the ability to cross‑train across multiple lines of business.
• Familiarity with Moda Health administrative policies and procedures affecting claims and customer service.
• Understanding of large group and individual healthcare insurance dynamics and provisions, including funding types, benefit designs, and Moda Health/Delta Dental benefit administration policies.
• Strong reading, writing and verbal communication skills with the ability to interact in a professional, patient, and courteous manner.
• Strong communication and collaboration skills.
• Ability to maintain confidentiality and exhibit a professional business demeanor.
• Strong analytical, problem‑solving, and decision‑making skills with keen attention to detail.
• Ability to quickly adapt to program changes while ensuring tasks are completed efficiently.
• Capacity to perform under pressure in a fast‑paced, complex environment with shifting priorities.
• Strong organizational skills with the ability to manage multiple projects and meet deadlines.
• Attendance that meets or exceeds company standards is expected.

• Conduct comprehensive audits across various customer service channels, including online chat, inbound/outbound phone calls, internal/external emails, and post‑contact surveys.
• Audit customer service interactions using approved criteria and NCQA guidelines; identify interactions requiring immediate coaching, follow‑up, or…