Supervisor, Medical Customer Service

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.

Let’s do great things, together!

This is a FT Hybrid position based in Milwaukie. This position provides supervision to a team of customer service representatives fielding calls from multiple sources regarding a wide range of plan types. Organizes staff, sets goals, ensures resources are available as needed, coaches and monitors representatives to develop their skills and knowledge in dealing with members, policyholders, brokers, providers, Sales & Account Services, and others.

Ensures calls are handled promptly, professionally, accurately, and courteously. Evaluates reports and results to ensure goals are achieved. Works collaboratively with the Medical Customer Service leadership team and the training department.

$65,682.16 - $82,107.97 annually (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.

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

• High School diploma or equivalent.
• 2-4 years’ experience (preferably including experience as a lead, trainer, or supervisor), including one or more of the following: claims processing, customer service, claims support.
• Strong reading, writing and verbal communication skills.
• Strong interpersonal skills necessary to deal with complex or challenging issues and people.
• Demonstrated analytical, problem solving and decision-making skills, particularly in a fast-paced environment.
• Microsoft Office experience, including Outlook, Word, Excel, and PowerPoint.
• Ability to maintain confidentiality and project a professional business presence and appearance.
• Ability to come in to work on time and daily, working the hours required to support the team and meet all goals and objectives.
• Must be able to work well under the pressure of frequent interruptions, the pressure to make good decisions on problems resulting from phone calls, the pressure of rapidly shifting priorities and the pressure of questions from many sources on many subjects.
• Must be able to adapt to frequent changes in policies and procedures, sometimes with short notice.

• Handles verbal inquiries/complaints from callers, and answers questions from Customer Service Representatives and numerous internal departments.
• Works with internal departments and external entities (providers’ offices, federal and state health insurance marketplaces, other carriers, and others) to obtain answers to caller questions as needed, and coordinate resolution of more complex caller issues.
• Understands and continually works to gain additional knowledge in policies and procedures surrounding benefits, claim processing and adjustments, appeals and authorizations, and has the ability to communicate this information accurately and concisely to staff and callers.
• Reviews and analyzes benefits on new and renewing groups and individual plans and communicates to staff information they will need to provide excellent service to callers.
• Communicates with Benefit Configuration, Billing and Eligibility, Provider Relations, and Sales to clarify benefits, intent, and procedures to provide customer service.
• Monitors Customer Service Representatives’ phone skills, delivery of accurate information and timely, complete follow-up from…