Supervisor, Membership Accounting

About Moda

Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, 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 and invites applicants that share this commitment.

Manage the day‑to‑day operational activities of the Moda and BHS Membership Accounting Department, ensuring retention of existing groups, members, regulators, and partners and improving the efficiency of all administrative services. Core management responsibilities include coaching, supervising, motivating, and supporting Membership Accounting Specialists. Measures and evaluates results to determine if standards are being met. This is a full‑time hybrid position based in Portland, Oregon.

$58,747.10 – $73,433.88 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
• 401(k) – Matching
• FSA
• Employee Assistance Program
• PTO and Company Paid Holidays

• Responsible for daily operation of billing, eligibility, and reconciliation functions of Medicare, Medicaid, Commercial Group, Individual, and/or BHS.
• Supervises and develops staff, develops goals, provides daily work direction, schedules vacations, monitors work and attendance, and handles hiring and terminating employees.
• Ensures that appropriate personnel policies and procedures are followed using coaching, counseling, performance evaluations, promotions, and demotions.
• Oversees training of new and existing staff on all billing and eligibility functions, all product lines, and ensures staff have necessary tools and resources.
• Assists staff with resolution of problem accounts involving eligibility, billing, and reconciliation.
• Maintains understanding of administering eligibility, billing, and reconciliation procedures for Medicare, Medicaid, ACA (Exchange), Employer Group, Retiree Administration, COBRA, etc.
• Assists in development and implementation of new systems and technology.
• Resolves complex problems and issues involving other departments, customers, state and federal regulators, agents/brokers, and constituents.
• Member of the Membership Accounting Leadership Team, assisting other Membership Accounting Teams as needed.
• Ensures excellent customer relations with internal and external customers, state and federal regulators, and agents/brokers.
• Stays aware of developments in business lines and assists with coordinating plan changes, open enrollment, and renewals.
• Promotes quality and continuous improvement within the department and the Membership Accounting division.
• Keeps Membership Accounting Manager and/or Director informed of department activities and concerns.
• Ensures department quality assurance standards and turnaround times are adhered to; develops measurement methods.
• Analyzes staffing needs and makes recommendations as workload fluctuates.
• Develops and approves all department policies and procedures (UPMs); works with Leadership Team on division level policies.
• Responsible for quality and process improvement.
• Performs other duties as assigned.

• College degree or four years relevant industry experience preferred.
• Knowledge of COBRA, retirement plans, Medicare, Medicaid, Commercial Group, Individual, Affordable Care Act, Private Exchanges, or TPA business.
• 4 years’ experience with Membership Accounting (enrollment, billing, reconciliation) preferred.
• Strong analytical, problem‑solving, decision‑making, and organizational skills.
• Ability to deal effectively with a variety of individuals, government organizations, agents, and groups related to service provision.
• Excellent verbal and written communication; ability to conduct meetings and presentations with internal and external stakeholders.
• Ability to achieve…