Job Description

Let’s do great things, together!

 

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.

Position Summary
The Supervisor of Health Navigators provides supervision to a team of Health Navigators fielding calls, email and chat based customer service inquiries for certain Performance Guarantee (PG) and Moda 360 groups. Organizes staff, sets goals, ensures resources available as needed, coaches and monitors reps to develop their skills and knowledge in dealing with members, policyholders, brokers, providers, Sales and Service and others. Ensures calls, email and chat are answered promptly, professionally, accurately, and courteously with the goal of providing one call resolution. Evaluates reports and results to ensure goals are achieved. This position requires staff to be flexible with their work schedule to meet the client’s needs. This is a FT Hybrid position based in Milwaukie, Oregon 

Pay Range
$71,990.85 - $89,988.57 annually (depending on experience)
*This role may be classified as hourly (non-exempt) depending on the applicant's location. 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.

Benefits :

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

Required Skills, Experience & Education:

1. High School diploma or equivalent.
2. 2-4 years medical, dental and/or pharmacy claim experience including claim processing and/or customer service and/or claim support.
3. Strong reading, writing and verbal communication skills.
4. Possess strong interpersonal skills necessary to deal with difficult issues and people.
5. Possess analytical, problem solving and decision-making skills.
6. Project Management skills desired.
7. Computer word processing and spreadsheet knowledge helpful.
8. Ability to work with multiple Pharmacy, Dental and Medical applications.
9. Must maintain confidentiality and project a professional business presence and appearance.
10. 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.
11. Empathy/passion for working with all types of customers.
12. Ability to come into work on time and on a daily basis.

Primary Functions :

1. Handles inquiries/complaints from members and providers, answer questions from Health Navigators, Customer Service Reps, Sales and Service, Provider Relations, policyholders, members, brokers, physicians, and numerous internal departments.
2. Must know and understand Medical, Dental and Pharmacy benefits, claim processing, appeals, chat, SMS, referrals/authorizations and all procedures related to claims and be able to communicate accurate information to staff and others.
3. Reviews and analyzes benefits for assigned groups and communicates to staff information they will need to service the customer.
4. Communicates with Medical, Dental and Pharmacy Benefit Programming, Membership Accounting, Professional Relations, Sales and Service to clarify benefits, update EBT, console to ensure accurate information can be provided by customer service.
5. Monitors Health Navigators to ensure quality and to ensure that collateral work resulting from phone calls, email or chat is completed and followed up promptly and on a timely basis. Ensures calls, emails and chat are answered within Moda 360/PG service level guidelines.
6. Provides direction to Health Navigators and keeps them informed of expectations and performance monthly.
7. Personnel administration including timekeeping, staffing, performance appraisals, interviewing and hiring, counseling, etc.
8. Works with other departments to resolve client related issues. Review and answer complaints, appeals, and grievances for Medical, Dental and Pharmacy.
9. Works with Membership Accounting to resolve issues such as ID cards and eligibility.
10. Assists and advises Reps helping members find providers (e.g., PCPs).
11. Works with Case Management, Healthcare Services, and providers to obtain preauthorization.
12. Reviews, analyzes, and develops process improvement implementation plans to ensure departmental processes are efficient. Once process improvement endeavor is implemented, evaluate, and modify as is appropriate.
13. Responsible for ensuring Health Navigators (new and seasoned) are well trained and information documented is clear and accurate to be able to answer callers’ questions accurately according to the plan benefits.
14. Assist with projects such as Chat, survey’s, Effortless Experience, Moda360 console etc. and make recommendations for improvement.
15. Work with Sales and Group to understand customer’s culture to better assist with the member’s needs.
16. Performs other duties as assigned including membership in cross-departmental committees and projects.

Working Conditions & Contact with Others

• Office environment with extensive close PC and keyboard use, constant sitting, and frequent phone communication. Must be able to navigate multiple computer screens. A reliable, high-speed, hard-wired internet connection required to support remote or hybrid work. Must be comfortable being on camera for virtual training and meetings. Work in excess of standard workweek, including evenings and occasional weekends, to meet business need.

• Internally with Healthcare Services, Pharmacy Clinical and Operations, Medicare Compliance and Operations, Membership Accounting, Sales and Account Services, Professional Relations, Claim Support, IT, and others. Externally with members policyholders, brokers, other carriers, and State agencies and Federal.

 

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. This is applicable to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absences, compensation, and training. 

For more information regarding accommodations, please direct your questions to Kristy Nehler & Danielle Baker via our humanresources@modahealth.com email.

Job Tags

Hourly pay, Full time, Work at office, Remote work, Flexible hours, Shift work, Afternoon shift

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