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    <title>Moda Health Jobs</title>
    <link>https://j.brt.mv/CompanyPortal.do?companyGK=14095&amp;portalGK=418</link>
    <description><![CDATA[Job Postings available for application.]]></description>
    <language>en-us</language>
    <pubDate>Wed, 22 Jul 2026 00:49:20 EDT</pubDate>
    <lastBuildDate>Wed, 22 Jul 2026 00:49:20 EDT</lastBuildDate>
    <generator>BrightMove ATS</generator>
    <item>
      <title><![CDATA[Lead Health Navigator - Internal Applicants Only - Milwaukie, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27781505&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>a4daf960-a24c-4014-8079-52e218962ef3</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.
Job Summary:
Provides phone, email, SMS and chat-based customer service to members of certain Performance Guarantee (PG) and Moda 360 groups by analyzing caller&rsquo;s needs and providing timely and accurate responses.  Answers inquiries from policyholders, members, agents, providers, hospitals, pharmacists, dentists and others regarding a wide variety of issues and questions related to a member&rsquo;s benefits and health program options. Supports Health Navigator team and supervisor.   This position requires staff to be flexible with their work schedule to meet the client&rsquo;s needs.  This is FT WFH role.
 
Pay Range
$28.04 - $31.54 hourly.
**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:
https://j.brt.mv/jb.do?reqGK=27781505&refresh=true
 

Benefits:

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

Requirements:

High school diploma or equivalent.
Minimum 1-2 years of experience at Moda (or equivalent experience outside of Moda) providing customer service in Medical, Dental and/or Pharmacy Customer Service.  CSR II or department equivalent preferred. Health Navigator experience strongly preferred.
Ability to meet and exceed all department standards and coach staff members to meet standards as well.
Strong verbal, writing and interpersonal skills.
Experience projecting empathy/passion for working with all customers and co-workers.
Strong analytical, problem solving, and decision-making skills with demonstrated ability to independently handle and resolve complaints, correct errors and resolve issues in accordance with Moda policies. 
10-key proficiency of 105 kpm net on a computer numeric keypad.
Type a minimum of 25 wpm net on computer keyboard. 
Ability to become a unit expert on online resources and applications including Facets, Benefit Tracker, Content Manager, MedAccess/Navitus, CoverMyMeds, Moda 360 Health Navigator Console, MS Teams, OneNote and others.
Ability to work well under pressure while providing excellent customer service and helping the unit meet all service levels.
Thorough knowledge of all groups assigned.
Thorough knowledge and understanding of requirements and Moda administrative policies effecting medical, dental and pharmacy claims.
Ability to maintain confidentiality and project a professional business presence and appearance.
Ability to back up supervisor, answer questions from CSRs, assist in training and complete reports.
Demonstrated ability to consistently organize work and time to meet deadlines and complete work in a timely manner.
Ability to maintain excellent attendance and punctuality and request time off with advance notice.
Demonstrated ability to comply with company rules and policies and project a positive and accepting attitude.
Completed Effortless Experience course and certification, or ability to complete soon after hire.

 
Primary Functions:

Provide back up and support to supervisor of unit.  This includes monitoring absence and overtime, monitoring phone line service levels, evaluating performance, training (individual and classroom), orientation, and one-on-ones with Health Navigators.  Assist in the hiring process and the employee disciplinary process.  
Answer medical, dental and pharmacy claim and benefit questions from internal and external customers and team members on Moda 360 dedicated groups.  Act as a primary resource for all departments on questions and issues relating to these groups.  Maintain knowledge in standard CS groups in order to assist those teams.
Handle escalated calls and issues from various sources, including incoming calls from customers and emails from internal departments.  
Assign work to staff as needed, including projects, outreach requests and task lists.
Gather and communicate monthly performance metrics and audit results to each staff member timely and completely.  
Review any rebutted audit results, listening to the call as needed.  Explain the rationale behind the audit or send to the Auditing team for review based on the outcome.  
Monitor Facets To-Do list, email inboxes and MS Teams chat regularly and prioritize questions and requests in order to meet the needs of staff members, their callers and other departments.  
Repeatedly analyze situations and communicate effectively in a fast-paced environment that includes working with frustrated or angry callers.
Use multiple resources simultaneously to research member issues or questions from staff, including Facets, Benefit Tracker, Content Manager, eviCore portal, Navitus, CoverMyMeds and other internal and external websites.  
Monitor phone and chat lines to assist in handling these contacts during periods of high volume.  
Provide accurate information timely and in a professional manner both verbally and in writing. 
Apply mathematical skills to determine correct benefit information and accurate customer service statistics.
Exercise judgment, initiative, and discretion with confidential and sensitive subject matter.
Provide thorough resolution when at all possible for members by using critical thinking skills, extending yourself and reducing effort on the part of the caller. This could include reaching out to internal and external sources (including service providers) to assist in resolving the issue for the member.
Assist team members in determining the best course of action and next steps for resolving caller issues, focusing on providing resources and support to allow them to better resolve issues independently in the future. 
Demonstrate empathy and respect for all team members and support positive communication within the team. 
Perform related duties:

Review, update and become familiar with new and revised benefit information and communicate to staff.  
Build and maintain proficiency in claim processing procedures to determine whether a claim was processed or adjusted correctly.  Communicate reasoning to callers and Health Navigators in language appropriate to experience level.  
Request claim adjustments required due to processing or configuration errors or new information and determine which incorrect processing is the result of a configuration error versus a processing error.  When a configuration error is encountered, communicate with the appropriate department to have it corrected.  
Identify confusing or incomplete information in all internal and external resources, plan documents and member communications and make suggestions for improvements.
Complete provider searches that may include calling several providers to locate providers who are in-network, available and meet the member&rsquo;s care needs.
Work with internal departments to help resolve member gaps in care when possible, including work with the Healthcare Services or Pharmacy teams on exceptions and authorizations.  
Advocate on behalf of members when they encounter issues with obtaining covered care or medications from providers or pharmacies.  
Place overrides to allow pharmacies to dispense medication at the point of service when appropriate based on plan details and internal policies.
Address and explain complaints, appeals, and grievances.
Provide customer service to walk-in members.
Contact physicians, dentists, hospitals, pharmacies and other providers when necessary to answer questions and obtain or provide information.
Send emails or text messages to members to follow up on call details or provide forms, website links or other plan documents and review Health Navigator emails for accuracy.  
Provide timely follow up and return calls when these are required.
Answer contacts as needed to maintain PG service level agreement.
Participate in User Acceptance Testing and workgroups as assigned.
Attend meetings with internal and external participants at all levels.  Create job aids and resources for staff, and request updates to Policy and Procedure manuals.
Monitor staff To-Do lists to ensure that they are completing tasks within department TAT, send reminders and offer support as needed to keep tasks current.  
Perform other related duties and projects as assigned by supervisor or manager.




Contact with Others & Working Conditions: 

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 Medical Claims, Healthcare Services, Dental Claims, Dental Provider Relations, Marketing, Group Integration, Medical Provider Relations, Pharmacy Operations, Case Management and others as needed to resolve the customer&rsquo;s issue. Externally with members, providers, pharmacies, attorneys, policyholders, brokers, service providers, and other insurance carriers.  May serve on committees and work with Sales, Manager, Directors, or Vice Presidents on special projects, member calls, etc.
 



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.
 
#INTONLY]]></description>
      <pubDate>Mon, 20 Jul 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Manager Medical Customer Service - Milwaukie, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27781552&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>cc218eaa-ad66-469a-bfec-09a0ad508f7b</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Position Summary
This is a FT Hybrid position based in Milwaukie, Oregon 
This role develops and maintains customer service policies, procedures, and guidelines for multiple lines of business in Oregon, Alaska, Idaho, and Texas:
&bull;    Commercial medical groups, including ASO and fully insured groups
&bull;    Individual medical groups
This role also ensures prompt, efficient, and accurate information is provided to staff, members, providers, and group administrators. Works closely with supervisors and senior leadership to develop, implement, and ensure consistency of processes and procedures across each line of business. Responsible for staff organization, service-level performance, goal setting, coaching, motivation, and staff development.



Pay Range
$78,911.43 - $98,639.28 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.

Please fill out an application on our company page, linked below, to be considered for this position.
https://j.brt.mv/jb.do?reqGK=27781552&refresh=true



Benefits:

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


Required Skills, Experience & Education:

Bachelor&rsquo;s degree or equivalent work experience specializing in business administration, customer service, and/or health insurance.
Minimum of four years of supervisory experience in medical, dental, and/or pharmacy customer service.
Demonstrated ability to effectively manage multiple lines of business concurrently.
Knowledge and understanding of Medicaid, Medicare, pharmacy, medical, and dental programs.
Ability to instruct, motivate, and direct individuals at various skill levels, both face to face and in a virtual environment.
Demonstrated strong, effective, and diplomatic interpersonal skills with employees at all levels.
Possesses and demonstrates strong presentation skills.
Excellent reading, oral, and written communication skills, with the ability to interact professionally, patiently, and courteously with internal and external customers.
Strong problem-solving and decision-making skills.
Ability to work well under pressure in a complex and rapidly changing environment.
Ability to maintain confidentiality and project a professional business presence and appearance.
Knowledge and understanding of contracts and administrative policies affecting claims.
Demonstrated consistent ability to comply with company rules and policies.
Maintains attendance above company standards.

 
Primary Functions:

Manages and oversees all functions within the Medical Customer Service team.
Strives to ensure all Moda performance guarantees, NCQA requirements, call goals, voicemail callbacks and email statistical goals are met.
Provides mentoring and development for supervisors to ensure performance standards are met.
Participates in workgroups to offer solutions and suggestions that support department goals. Manages current processes and develops innovative solutions to meet and exceed department measures and metrics.
Plans, organizes, and directs department workflow to ensure staff performance expectations, including quality and quantity goals, are reasonable and met. Reviews performance issues with supervisors and takes disciplinary action when appropriate. Drafts, implements, approves, and executes policies and procedures that support a quality customer service experience.
Assesses and oversees process improvement implementation plans to ensure departmental processes are efficient. After process improvements are implemented, evaluates and modifies them as appropriate.
Ensures prompt, efficient, and accurate customer service administration by developing and implementing appropriate goals with the Director.
Reviews monthly, quarterly, and annual statistical reports.
Ensures language access contracts for member and provider vendors are in place and functioning as intended.
Provides written narratives and reviews data for quarterly NCQA reports for Commercial Medical in all states.
Provides direction to supervisors and keeps them informed of expectations and performance on a monthly basis. Sets short-term and long-term objectives for supervisory staff and provides resources to ensure goals are met. Provides constructive and timely performance evaluations.
Oversees hiring, training, orientation, performance appraisals, scheduling, and corrective action for staff.
Recruits, interviews, hires, and trains departmental supervisory staff.
Coordinates with the Training Manager, Operations teams, and supervisors to provide initial and ongoing staff training.
Works with the Director to review and advocate for departmental staffing projections and budget needs. Recommends appropriate staffing requirements based on projected new sales and business retention.
Coordinates with Human Resources and supervisors to ensure departmental recruitment efforts remain on track.
Works cooperatively companywide with Claims, Membership Accounting, Marketing, Operations, Healthcare Services, Compliance, and Sales and Service Management. Serves on project teams and committees for all areas as appropriate.
Provides annual review of plan documentation, websites, and benefit programs to ensure accurate annual updates for medical departments.
Provides oversight and direction for departmental involvement in various annual user acceptance testing projects.
Identifies areas for improvement within departments and across functions. Leads improvement efforts where appropriate and evaluates and manages cross-training to maximize productivity.
Ensures phone lines are directed correctly for weekend and holiday coverage and are adequately staffed for Texas lines of business.
Performs other duties as assigned by leadership.


Working Conditions & Contact with Others


Work is performed while seated or standing for prolonged periods. The position requires close work with a PC monitor and keyboard, along with constant interaction with others by phone, virtually, and in person. The role may require working more than 40 hours per week, including evenings and occasional weekends, to meet business needs.

Interacts internally with staff and departments at all levels. Interacts externally with members, providers, policyholders, group administrators, vendors, and other insurance carriers.

 
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.]]></description>
      <pubDate>Mon, 20 Jul 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Supervisor, Medical Claims - Milwaukie, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27778908&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>ff0d7080-79ad-460c-80bc-1eefabf1c5d5</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Position Summary
Provides supervision, coaching and support to Claims Processors.  Organizes staff, sets goals, establishes procedures, and continues to ensure claims are processed promptly and accurately.  Measures and evaluates performance and results.  Coaches and trains as required to achieve goals of quality and efficiency. This is a FT hybrid position based in Milwaukie, Oregon.

Pay Range
$59,922.05 - $74,902.56 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.

Please fill out an application on our company page, linked below, to be considered for this position.
https://j.brt.mv/jb.do?reqGK=27778908&refresh=true



Benefits:

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

Required Skills, Experience & Education:

College degree or equivalent work experience.
2 &ndash; 4 years medical claims processing experience, including 1 year as Senior/Lead processor.
Computer proficiency in company&rsquo;s systems and Word and Excel.
Strong verbal, written and interpersonal communication skills.
Strong analytical, problem solving and decision-making skills.
Ability to work well under pressure with frequent interruptions and shifting priorities.
Ability to come in to work on time and daily.
Maintain confidentiality and project a professional business image.


Primary Functions:

Supervises staff giving daily work direction, vacation scheduling, monitoring attendance, conducting performance reviews, and hiring and training new employees.
Facilitates problem solving for employees and Manager by answering claims related questions dealing with contract interpretation of benefits, procedures and claims systems.
Controls workflow and quality by checking date and amount of work in processors queues, assigns work to ensure time service goals, tracks processors production and quality.
Assists with planning by analyzing amount of work and type of work, assigns and sets priorities and decides on retraining needs.
Motivates and coaches the processors by reviewing results with them, conveys to them what is expected of them, asks for suggestions, and fulfills the needs of training.
Use and manipulate excel files. 
Other duties as assigned.

 
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 staff, Underwriting, Professional Relation, Claims Support, Accounting, and IT.  Externally with providers, policyholders, insureds, and brokers.
 

 
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 and Danielle Baker via our humanresources@modahealth.com email.]]></description>
      <pubDate>Thu, 16 Jul 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Supervisor, Healthcare Services Claims - Internal Applicants Only - Portland, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27779680&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>2817dcba-a9e8-4382-8b4c-c69fe8d4a220</guid>
      <description><![CDATA[About Moda
Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we&rsquo;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&rsquo;s be better together.

Position Summary:
Provides supervision, coaching and support to Claims Processors.  Organizes staff, sets goals, establishes procedures, and continues to ensure claims are processed promptly and accurately.  Measures and evaluates performance and results.  Coaches and trains as required to achieve goals of quality and efficiency. This is a Hybrid Position. 
 
Pay Range
$59,922.05 - $74,902.56 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.
https://j.brt.mv/jb.do?reqGK=27779680&refresh=true
 
Benefits:

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


Required Skills, Experience & Education:

College degree or equivalent work experience.
2 &ndash; 4 years medical claims processing experience, including 1 year as Senior/Lead processor.
Computer proficiency in company&rsquo;s systems and Word and Excel.
Strong verbal, written and interpersonal communication skills.
Strong analytical, problem solving and decision-making skills.
Ability to work well under pressure with frequent interruptions and shifting priorities.
Ability to come in to work on time and daily.
Maintain confidentiality and project a professional business image.

 
Primary Functions:

Supervises staff giving daily work direction, vacation scheduling, monitoring attendance, conducting performance reviews, and hiring and training new employees.
Facilitates problem solving for employees and Manager by answering claims related questions dealing with contract interpretation of benefits, procedures and claims systems.
Controls workflow and quality by checking date and amount of work in processors queues, assigns work to ensure time service goals, tracks processors production and quality.
Assists with planning by analyzing amount of work and type of work, assigns and sets priorities and decides on retraining needs.
Motivates and coaches the processors by reviewing results with them, conveys to them what is expected of them, asks for suggestions, and fulfills the needs of training.
Use and manipulate excel files. 
Other duties as assigned.

 
Working Conditions:
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.
 
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.
 
#INTONLY]]></description>
      <pubDate>Thu, 16 Jul 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[​​Supervisor, Medical Customer Service​ - Milwaukie, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27781394&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>278cede4-913b-4ad8-834d-6e3e41c5092b</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Position Summary
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. This is a FT Hybrid position based in Milwaukie, Oregon 

Pay Range
$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.

Please fill out an application on our company page, linked below, to be considered for this position.
https://j.brt.mv/jb.do?reqGK=27781394&refresh=true



Benefits:

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


Required Skills, Experience & Education:

High School diploma or equivalent.
2-4 years&rsquo; 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. 

 
Primary Functions:

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&rsquo; 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&rsquo; phone skills, delivery of accurate information and timely, complete follow-up from caller issues.
Monitors Customer Service Representatives&rsquo; work habits, including schedule adherence, time available to take calls, time management and work to be completed during downtime.
Provides direction to Customer Service Representatives sets clear expectations and reviews performance monthly.
Handles personnel administration including timekeeping, performance appraisals, interviewing and hiring, counseling, coaching and performance improvement plans.
Reviews, analyzes, and develops process improvement implementation plans to ensure departmental processes are efficient, and continues to evaluate and modify plans as needed to ensure continued success.  
Works with the Training department and other departments as needed to ensure that Customer Service Representatives are well-trained, and information documented is clear and accurate.
Works collaboratively with all Medical Customer Service leadership including director, managers, supervisors, leads and trainers to ensure clear, consistent communication of goals and processes across the department.
Writes, reviews, updates, and communicates new and revised processes and procedures, including writing and updating procedure manuals, job aids, website postings, emails and training materials.
Participates in inter-departmental and cross-departmental meetings, committees, and projects.
Performs other duties as assigned.


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 all departments, most commonly Healthcare Services, Membership Accounting, Privacy and Security, Marketing, Sales, Provider Relations, Claims Support, Information Technology, Benefit and Provider Configuration. Externally with members, service providers, caregivers, policyholders/employers, brokers, other carriers, State agencies, and all others who call in to Medical Customer Service.  

 
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.]]></description>
      <pubDate>Thu, 16 Jul 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[RX Prior Authorization Coord I - Portland, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27781395&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>fac41c1c-2a81-46f0-81e5-5ef1f613f7fe</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Position Summary
Utilizes the electronic prior authorization (PA) platform to process pharmacy PAs in accordance with clinical criteria and plan benefits while ensuring that the necessary data is inputted into the claims adjudication system for successful claims processing. This is a FT WFH role.


Pay Range
$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.
https://j.brt.mv/jb.do?reqGK=27781395&refresh=true



Benefits:

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


Required Skills, Experience & Education:

High School diploma or equivalent required. College degree preferred. Equivalent work experience in health care administration, pharmacy, or other health related fields may substitute for the education requirement.
Minimum one year working experience in a prior authorization or technician role in a pharmacy or health plan.
State Pharmacy Technician license required for all external applicants. Internal applicants are required to obtain one within six months of hire date. CPhT is preferred but not required.
Demonstrated critical decision making, ability to interpret benefit contracts, clinical criteria and Moda Health administrative policies.
Demonstrated working knowledge of medical and pharmaceutical terminology and computer skills including Microsoft Office products (proficiency with Word and Excel).  Must be able and willing to learn a third-party real-time interactive PBM claims adjudication system, where great attention to detail is imperative.
Ability to gain proficiency in Moda internal systems, electronic PA platform and PBM claims processing systems.
Typing proficiency of 40 wpm on a computer keyboard.
Willingness to work hours necessary to successfully accomplish assigned tasks.
Abilities to anticipate needs and multi-task; consistently meet quality and production standards; maintain a high level of confidentiality; project a professional business image; be flexible and adapt to change; handle stress and pressure.
Sound analytical problem solving, decision making, memory retention, and organizational skills.
Excellent verbal, written, and interpersonal communication skills including active listening, teamwork, working respectfully with co-workers and members.
Preference for fast-paced, production-oriented environment.
Must have the to resolve pharmacy conflicts in a professional manner.
Ability to come to work on time and daily.


Primary Functions:

Accountable for accurately entering PAs into multiple systems, tracking requests, and meeting timeline requirements for decisions and notifications of decisions to members and providers according to corporate policy and government regulations.
Responsible for the first pass assessment and evaluation of the PA request prior to higher level review: prepares, assesses, evaluates, and makes initial determination on the PA request with the information received using established criteria.
Utilizes critical decision-making skills to interpret formulary coverage and reviews PA requests according to coverage criteria and plan benefits. Prepares necessary documentation and triages requests to the clinical team to determine the outcome.
Interprets contracts (evidence of coverage, handbooks, summary of benefits etc.) and determines actions required.
Solves pharmacy plan benefit and formulary issues for members of multiple commercial and ACA plans. Must be able to accurately distinguish member benefit plans and determine member eligibility across varying lines of business and according to varying State requirements.
Screens requests for formulary status (e.g., PA required, non-formulary excluded, quantity limits, etc.).
Monitors pharmacy turn-around time deadlines and takes action to ensure required timelines are met. Adheres to timelines set forth by the National Committee for Quality Assurance (NCQA)
Determines whether additional information is needed from the requesting provider&rsquo;s office and triages the request to the Rx Assistants.
Communicates PA decisions and ensures appropriate feedback and follow-up for all PA requests via electronic interface, fax, telephone, and/or email to requesting providers, members, pharmacies, and internal departments within the promissory timeframes.
Supports, tracks, maintains and ensures data and documentation for member appeals, grievances and complaints are provided within necessary timelines.
Interacts with providers and provider offices via electronic interface, fax and/or telephone to gather complete, accurate information to adequately process a PA.
Acts as an active team player, responding to the needs of the unit as they arise.
Other duties as assigned


 
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 own department, primarily with the Clinical team, Operations and Customer Service; as needed with Appeals, Healthcare Services, Marketing, and Medicare Programs.  Externally with Moda members, PBM vendor, providers, provider offices, pharmacists, and pharmacies. 
 

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 and Danielle Baker via our humanresources@modahealth.com email.]]></description>
      <pubDate>Thu, 16 Jul 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Sales Assistant I - Temporary - Portland, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27781393&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>ac89d0e8-3545-46c5-aa3f-74e7379ef315</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Position Summary
Provides internal administrative assistance to the Account Manager. Provides daily access for Agents, Group Administrators and Sales and Services staff by phone, email and in person. Provides administrative support necessary to meet sales and service objectives. This is a temporary hybrid position.

Pay Range
$18.39 - $20.58 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.
https://j.brt.mv/jb.do?reqGK=27781393&refresh=true



Benefits:

Medical, Dental, Vision & Pharmacy
PTO and Company Paid Holidays
401k - Matching

 

Required Skills, Experience & Education:

At least 6 months office experience preferably in health insurance and/or employee benefits/administration field and/or sales and account management practice.
Computer proficiency with Microsoft Office applications (Word, Excel, Power Point).
Knowledge of health insurance business as it relates to contracts, state, and federal law.
Understanding of systems regarding enrollment and eligibility, processing of claims, billing, customer service, and related information.
Ability to learn underwriting policies and procedures for assistance with small and large groups
Ability to work well under pressure with frequent interruptions and shifting priorities.
Strong analytical, problem solving and decision-making skills.
Ability to come in to work on time and daily; Overtime is evaluated and set during peak times
Strong verbal, written and interpersonal communication skills.
Presents a positive and professional image in the community; Maintains confidentiality and projects a professional business image.
Maintains a valid driver&rsquo;s license.
Ability to handle a pushcart/hand truck and ability to lift boxes up to 40 lbs.
Ability to be a self-motivator and work independently with little or no supervision.

 
Primary Functions:

Supports Sales and Service objectives by preparing accompanying materials for the Account Managers, as needed; Provides back-up support for other Sales Assistants, as needed.
Audit group renewal letters and ensures letters are mailed within the advance notice time frame, as outlined in contract.
Pulls various Business Objects Reports, as assigned by Account Manager.
Prepares internal and external correspondence for Sales and Services team (i.e., renewal paperwork, cancellation, and delinquency notices, etc.), as assigned.
Acts as a liaison between various internal departments and the Account Manager when they are out of the office.
Completes and submits appropriate Group Applications to Business Implementation Unit within three business days to ensure external timelines are met and or exceeded.
Responds timely to high volume of emails and phone calls from external and internal clients; Provides excellent customer service.
Prepares Welcome/Enrollment packets and group administrative kits, on as needed basis.
Works efficiently in Facets, Agent Database, Business Objects, WiredEnroll and other systems.
Acts as a liaison between callers and internal departments (Agent Desk, Membership Accounting, etc.).
Supports department by preparing training materials; Reviews and provides feedback on assigned.
Provides training and support for temporary and newly hired full-time Sales Assistants.
Evaluates marketing materials, brochures, flyers, and other documents, as assigned.
Perform other duties as assigned.



Working Conditions & Contact with Others

Office environment with extensive close PC and keyboard work, constant sitting, and phone work. Must be able to navigate multiple screens. Must be able to travel and to work with challenging clients. Work in excess of 37.5 hours per week, including evenings and occasional weekends, to meet business need.
Internally within Sales department, Membership Accounting, Business Implementation Unit, Benefit Configuration, Underwriting, Document Services, Accounting, Marketing, and other departments as needed. Externally with policyholders, agents, members, and vendors (i.e., pharmacy and provider networks, etc.)

 
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.]]></description>
      <pubDate>Thu, 16 Jul 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[RN Care Coordinator - Portland, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27779257&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>5ae995cf-c429-4553-ba75-bbff4d6973fe</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Job Summary:
Performs care coordination within the boundaries of the company&rsquo;s policies and procedures to ensure appropriate care is delivered in a timely manner and within the appropriate setting for members. Interacts with the member, family, and care providers to develop, coordinate, and monitor the member&rsquo;s treatment plan.
This is a FT WFH position.
 
Pay Range
$71,990.85 - $89,988.57 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.

Please fill out an application on our company page, linked below, to be considered for this position.
https://j.brt.mv/jb.do?reqGK=27779257&refresh=true 

Benefits:

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


Primary Functions:


Investigates opportunities for health care alternatives and prepares cost effective plans to offer patients, families, and providers.
Identifies health services vendors to use in Care Coordination and coordinates with providers for member&rsquo;s benefits as well as identifies and utilizes community resources that may be available to member.
Works closely with members, families, and providers, typically by telephone to outline a clear, proactive plan of care with patient goals and objectives and measurements to attain the same.
Effectively use the company&rsquo;s internal systems to accurately determine eligibility, benefit plan, physician networks associated with the member&rsquo;s plan. Documents accurate, readable, narrative notes related to cases and identifies and researches any problems and offers reasonable solutions.
Maintains an acceptable caseload within the guidelines outlined within the department&rsquo;s policies and procedures and works assigned schedule to maintain phone coverage between the hours of 7am &ndash; 5:30pm, this includes closing cases in appropriate timeframe per department standards and maintain RN audit scores at or above the 90% benchmark.
Applies clinical expertise and judgment to ensure compliance with medical policy and criteria of for accepted standards of care while performing Utilization Review and Service Authorizations for members of assigned employer groups.
Consults with physician advisors to ensure clinically appropriate determinations.
Refers appropriate cases to Case Manager RNs for assessment.
Provides approvals and denials of requests in a professional and positive manner.
Reports on any case entered on the High Dollar Report in Rounds meetings.
Develops professional relationships with internal departments, including effectively communicating with support staff and customer service staff.
Contributes to the ongoing efforts of the department to foster a collaborative and team approach to case load.
Performs other duties as assigned.


Required Skills & Experience:

Graduate of accredited 2-4 year program of nursing school.
Holds current unrestricted Oregon Registered Nurse license.
Must have 3 years recent hospital, home health, or acute care experience.
Type a minimum of 35 wpm on a computer keyboard and be proficient with Microsoft Office applications.
Strong analytical, problem solving, memory retention, organizational and detail-oriented skills.
Excellent communication skills with the ability to interact with all levels of staff, members and providers as needed.
Ability to be a self-starter and identify training needs of department.
Ability to defuse difficult/angry calls and work towards a positive resolution.
Ability to work well under pressure with constantly shifting priorities.
Ability to maintain confidentiality and project a professional business image.

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 and Danielle Baker via our humanresources@modahealth.com email.]]></description>
      <pubDate>Wed, 15 Jul 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Medicaid Financial Accountant II - Portland, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27778390&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>9db838a5-9a06-47cc-8160-2654a44358a4</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Position Summary
This is a hybrid position based in Portland, Oregon.
As the Medicaid Financial Accountant in Moda&rsquo;s Accounting department, you will be responsible for the preparation of the accounting and reporting of the Company&rsquo;s Coordinated Care Organization (Eastern Oregon Coordinated Care Organization). You will report to the Medicaid Financial Accounting Supervisor, with additional oversight from the Medicaid Financial Accounting Manager, and work collaboratively with the Financial Accounting team of approximately 18 to ensure the complete and accurate accounting and reporting of the Company&rsquo;s financial data for Eastern Oregon Coordinated Care Organization (EOCCO). Additionally, you will regularly interact with a broader group both in and out of the Accounting department, namely the Medicaid Services department along with the Actuarial department, as well as interface with various financial stakeholders external to the Company. 

Pay Range
$80,000 - $105,000 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.

Please fill out an application on our company page, linked below, to be considered for this position.
https://j.brt.mv/jb.do?reqGK=27778390&refresh=true


Benefits:

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


Required Skills, Experience & Education:

Bachelor degree in Accounting or Finance; Accounting preferred.
3+ years public accounting or Financial accounting experience; CPA preferred but not required.
Strong understanding of accounting concepts and Generally Accepted Accounting Principles (GAAP). 
Understanding of Statutory Accounting Principles (SAP) preferred. 
Strong analytical and problem solving skills, including understanding of T-Accounts, and ability to work through difficult accounting scenarios.
Experience with or exposure to various forms of financial reporting, including preparation of financials, footnotes and electronic tie outs.
Strong verbal, written and interpersonal communication skills.
Ability to work well under pressure to meet strict deadlines, as well as ability to maintain flexibility to shift priorities and reprioritize.
Strong time-management and organization skills; ability to move multiple work streams forward at once and actively prioritize projects.
Proficiency with Microsoft applications (Word, Excel, PowerPoint). Use of pivot tables, vlookups, and other moderately difficult Excel functions required.
Ability to maintain confidentiality and project a professional business image with both internal and external parties.
Willingness to work additional hours when necessary.

 
Primary Functions:

Ensure the integrity of the GAAP general ledger by completing the monthly financial close for EOCCO. This will include detailed journal entry preparation and analysis of financial results (through the completion of a monthly financial package). 
Ensure that 100% of account reconciliations are completed monthly for EOCCO. Further, must have ability to create/propose appropriate reconciliations for new accounts or processes as needed (i.e. assess appropriateness of ending account balance and develop reconciliation approach).
Prepare payment requests for this entity that are owned by the Accounting department; maintain calendar schedule of recurring payment due dates. 
Prepare quarterly and annual reporting to be filed with the OHA and NAIC.
Prepare reporting and presentations for EOCCO board.  
Demonstrate high levels of independent ownership, in addition to working collaboratively with the department, in order to maintain adherence to close calendar, both for monthly close as well as quarterly and annual close.
Independently prepare various schedules, including standalone entity financial statements, in support of the annual external audit, when assigned.
Perform detailed reconciliation and/or reporting projects related to various Medicaid initiatives. 
Attend and participate in various meetings, including working internally with Moda employees as well as externally with other Medicaid-related organizations. 
Stay informed of current financial reporting and accounting issues, including those prescribed by OHA.
Works with other departments as necessary to ensure financial statements are complete and accurate; works to understand and/or test the completeness and accuracy of key sources of data (key reports).
Demonstrates continuous effort to exhibit ownership over key responsibilities, improve operations, and streamline work processes to create efficiencies.
Perform other duties or projects as assigned.  

 
Working Conditions & Contact with Others

This position works closely with others in the Accounting department (approximately 40 people), as well as with others throughout the Company including the areas of: Medicaid Services, Underwriting & Actuarial, IT, Internal Audit, Claims and Benefit & Provider Configuration. Externally, this position will work with external auditors, state regulators and various other plan partners. Attendance and participation at meetings will be required.

Extensive close keyboard and PC work, constant sitting (stand up desks available if in line with company policy).  Work in excess of standard work week.

 

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 and Danielle Baker via our humanresources@modahealth.com email.]]></description>
      <pubDate>Tue, 14 Jul 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Clinical Care Advance Configuration Analyst I, II or III - Portland, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27770747&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>0e0d4c53-1e03-4aea-8c60-b0221f591fa3</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Position Summary
The CCA Configuration Analyst III is responsible for the analysis, design, and maintenance of the Clinical Care Advance system and other assigned systems, serving as a subject matter expert who identifies and resolves configuration issues, recommends improvements, and ensures high quality work. The role works closely with peers and management to troubleshoot system issues, support requirements and updates, and ensure interdepartmental needs are met, while also maintaining working knowledge of related enterprise systems such as Facets. The position provides recommendations for vendor system enhancements, tests delivered enhancements, and integrates them into ongoing configuration strategies. This is a FT WFH position. 

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.
https://j.brt.mv/jb.do?reqGK=27770747&refresh=true


Benefits:

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


Required Skills, Experience & Education:

Bachelor&rsquo;s degree in business or healthcare related field. Equivalent education and experience may be considered.  
Minimum of 5 years of experience in a Systems Configuration, Claims, or Operations department within a healthcare organization.  
2 to 5 years of experience working with clinical and care management systems such as the CareAdvance Enterprise Application.  
Working knowledge of enterprise systems such as Facets.  
Advanced knowledge of health plan configuration, including healthcare services, medical management, population health management, and industry care guidelines such as Milliman Care Guidelines.  
Knowledge of configuration change management methodologies, standards, and best practices.  
Experience with project management methodologies and the ability to manage projects and initiatives independently end to end.  
Proficiency in Microsoft Office products.  
Ability to understand business needs at both clinical and technical levels and translate them into configuration requirements.  
Ability to analyze processes, document workflows, perform gap analysis, and develop future state standardized workflows.  
Strong communication and meeting facilitation skills, with the ability to collaborate effectively with peers, management, and vendors.  
Strong analytical, organizational, and time management skills, with the ability to meet agreed upon timelines with accuracy.  
Ability to work well under pressure with constantly shifting priorities.  
Ability to maintain regular attendance, confidentiality, and a professional business image. 

 
Primary Functions:

Gather and document requirements, perform analysis, and develop configuration design to meet business needs. 
Manage complex system configuration and related documentation. Serve as a subject matter expert for configuration change management testing and best practices. Facilitate production controls and system configuration data codification. 
Monitor and review system edits and conduct advanced root cause analysis to identify issues and provide clear recommendations for resolution, including issues requiring multi-disciplinary technical skills. 
Identify and facilitate the implementation of process improvements and best practices. 
Interface and collaborate with peers and management throughout Healthcare Services and the organization to support configuration management best practices and system configuration life cycle management. Support project and program plans and tracking of configuration changes, operational issues, and resolutions. 
Represent the team on internal and external committees related to the system solution. 
Provide system-based recommendations regarding enhancement requests and the implementation of enhancement features. 
Lead and manage configuration project timelines to meet agreed upon deliverables. 
Coordinate the preparation and execution of test plans to validate that configuration updates and system fixes are complete and accurate and that enhancements function as designed. 
Perform other duties as assigned. 

 
Working Conditions:

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 multiple departments.  Externally with vendor and other health plans. 

 
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.]]></description>
      <pubDate>Fri, 10 Jul 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[RN Delegation & Quality Coordinator - Portland, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27780850&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>64b163bd-bc4d-4bbf-9c25-0c50fd4ee113</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Position Summary

Responsible for coordinating and performing all oversight activities to ensure compliance with NCQA, State and Federal requirements for the delegated UM functions. Audits the delegates&rsquo; structure, programs, operational design, and denial decisions. Ensures compliance and maintains readiness for accreditation organization audits. Conduct quarterly Delegation Oversight Committee meetings.  Document discussions regarding compliance and delegated functions in meeting minutes. This is a hybrid position based in Portland. 

Pay Range
$71,990.85- $89,988.57 annually 
**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.
https://j.brt.mv/jb.do?reqGK=27780850&refresh=true
Benefits:

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

 Requirements:

Requires current unrestricted Oregon Nursing license as a registered nurse with 
Experience in healthcare management and knowledge of regulatory requirements 
Have a strong understanding of NCQA
Type a minimum of 35 wpm on a computer keyboard.
Proficiency with personal computer programs such as Microsoft Word and Excel.
Analytical, problem solving, memory retention, organizational and detail oriented.
Excellent verbal and interpersonal communication skills including management of the angry customer.
Ability to work well under pressure.
Ability to come into work on time and daily.
Project a professional business image telephonically and in person.
 

Primary Functions:
Perform pre-delegation review in accordance with NCQA requirements including: 

Review of all relevant policies and procedure
Review of ability to perform delegated function in the appropriate time frames
Review of clinical policies and comparison with current Moda Health guidelines
Review of contract terms and knowledge of scope of delegated activities
Review of workflow to implement delegated activities
Pre-delegation audit of sample files
Organizes site visit, agenda, and preparation of audit tools for pre-delegation review
Report pre-delegation review findings to the Medical Quality Improvement Committee

 
Perform annual review of delegation including:

Annual review of program documents and structure
Review of reports associated with delegated functions
Perform audit of selected files
Review updates to clinical policies and compare with Moda Health guidelines
Submit corrective action plans for non-compliant issues and review progress
Organizes site visit, agenda, and audit tool for annual file review
Report outcomes to the Medical Quality Improvement Committee
Ability to take initiative and problem solve
Work independently and as part of an integrated team
Performs other duties as assigned

Contact with Others

Internally with own department, Medical and Dental Customer Service, Professional Relations, Marketing, Medical Claims, Actuarial (Underwriting), Information Systems and Human Resources. Externally with accreditation organization, providers, provider offices and hospitals, members, and groups.

Working Conditions
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.
 
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.]]></description>
      <pubDate>Wed, 08 Jul 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Health Navigator I - Milwaukie, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27780727&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>f8fbea44-49db-4a61-b78d-b34e05302d79</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.
Job Summary:
Provides phone, email and chat-based customer service to members of certain Performance Guarantee (PG) and Moda 360 groups by analyzing caller&rsquo;s needs and providing timely and accurate responses.  Answers inquiries from policyholders, members, agents, providers, hospitals, pharmacists, dentists and others regarding a wide variety of issues and questions related to a member&rsquo;s benefits and health program options.  This position requires staff to be flexible with their work schedule to meet the client&rsquo;s needs. This is FT WFH role.
Pay Range
$21.30 - $23.96 hourly.
**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:
https://j.brt.mv/jb.do?reqGK=27780727&refresh=true

Benefits:

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

Requirements:

High school diploma or equivalent.
Ability to complete training as a Customer Service Representative with Moda Health.
Claim processing experience, prior customer service experience or other related experience such as medical/dental office or pharmacy preferred.
Practical knowledge of medical, dental and/or pharmacy terminology desired.
Knowledge of diagnosis and procedure coding helpful.
Excellent oral and written communication skills. Ability to interact professionally, patiently, and courteously with customers over the phone and in writing.
Excellent analytical, problem solving and decision-making skills.
10-key proficiency of 105 kpm net on a computer numeric keypad.
Type a minimum of 25 wpm net on computer keyboard.
Ability to work well under pressure in a complex and rapidly changing environment.
Ability to maintain excellent attendance and punctuality.
Maintain confidentiality and project a professional business presence.
Ability to work with multiple applications across multiple monitors at once and learn new applications as needed.
Experience using Microsoft Office products including Outlook, OneNote and Teams.
Experience with TriZetto Facets helpful.
Ability to learn independently and take initiative to constantly improve skills.
Though open to both internal and external candidates, internal candidates must be Fully Meeting performance expectations in their current position.  Exceeding in Accuracy and Customer Service Skills is preferred.   
Complete Effortless Experience training and certification after hire.

Primary Functions:

Applicants will handle either medical, dental or pharmacy inquiries or a combination of two of these, depending on existing skills and training.  Opportunity for promotion to Health Navigator II upon learning all three lines of business. 
Answer medical, dental and/or pharmacy claim, authorization and benefit questions from customers on specific groups.  Provide solutions to problems, confirm eligibility and explain benefits and plan coverage.
Handle inquiries received via phone, email, voicemail and/or online chat.
Respond to members via phone, online chat, SMS and email. 
Complete detailed research and follow-up as needed.  May include use of multiple resources, contact with internal departments and multiple phone calls to providers, pharmacies and other carriers to resolve a situation completely. 
Work with internal departments via email, phone or meetings to resolve member issues and ensure clear communication of the member&rsquo;s needs. 
Repeatedly analyze situations and communicate effectively in a fast-paced environment that includes working with frustrated or angry callers.
Use the Moda 360 Navigator Console to review recommended health actions and programs, recommend programs based on personalized member data and assist members in understanding and setting up programs or completing recommended health actions. 
Use multiple resources simultaneously to research member issues.  These could include Facets, Benefit Tracker, Content Manager, eviCore portal, Navitus, CoverMyMeds, Moda 360 Navigator Console and other internal and external websites depending on the line(s) of business. 
Provide complete and accurate information in a professional manner both verbally and in writing.
Talk on the phone or respond via chat while simultaneously researching the caller&rsquo;s questions and documenting the interaction.
Apply mathematical skills to determine correct benefit and claim information and manually calculate and update dental incentive levels when needed.
Exercise judgment, initiative, and discretion with confidential and sensitive subject matter.
Provide thorough resolution when at all possible for members by using critical thinking skills, extending yourself and reducing effort on the part of the caller. This could include reaching out to internal and external sources (including service providers) to assist in resolving the issue for the member and making multiple follow-up calls to the member until the issue is resolved.
Perform related duties:

Review, update and become familiar with new and revised benefit information. 
Build and maintain proficiency in claim processing procedures to determine whether a claim was processed or adjusted correctly.  Communicate reasoning to callers in language appropriate to the caller&rsquo;s experience level. 
Request claim adjustments required due to processing or configuration errors or new information and determine which incorrect processing is the result of a configuration error versus a processing error.  When a configuration error is encountered, communicate with leadership to have it corrected. 
Identify confusing or incomplete information in all internal and external resources, plan documents and member communications and make suggestions for improvements.
Update and enter primary care physician selections based on plan benefits (medical only).
Complete provider searches that may include calling several providers to locate providers who are in-network, available and meet the member&rsquo;s care needs.
Work with internal departments to help resolve member gaps in care when possible, including work with the Healthcare Services or Pharmacy teams on exceptions and authorizations for those trained in medical or pharmacy, respectively. 
Advocate on behalf of members when they encounter issues with obtaining covered care or medications from providers and/or pharmacies. 
Place overrides to allow pharmacies to dispense medication at the point of service when appropriate based on plan details and internal policies (pharmacy only).
Address and explain complaints, appeals, and grievances.
Provide customer service to walk-in members.
Send emails or text messages to members to follow up on call details or provide forms, website links or other plan documents.
Send faxes to providers to allow them to submit medication authorization requests (pharmacy only).
Provide timely follow up and return calls when these are required.
Answer calls within PG service level agreement.
Complete continuing education on excellent customer service skills. 
Perform other related duties and projects as assigned by lead, supervisor or manager.




Contact with Others & Working Conditions: 

Constant sitting and telephone use.  Close PC monitor and keyboard work.  Must be able to work with multiple applications open on multiple monitors and to type documentation and research while speaking with a caller.  Constant interaction with others on the phone, in writing and in person.  Video calls via MS Teams when required by supervisor or manager.
Inside the company with Medical Claims, Healthcare Services, Dental Claims, Dental Provider Relations, Marketing, Group Integration, Medical Provider Relations, Pharmacy Operations, Case Management and others based on the line of business and as needed to resolve the customer&rsquo;s issue. Outside the company with members, providers, attorneys, policyholders, brokers, service providers, pharmacies and other insurance carriers.
 



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.]]></description>
      <pubDate>Mon, 06 Jul 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Pharmacy Customer Service Representative - Milwaukie, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27780728&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>ac82e1df-b6ec-4237-a7a3-a39d55226249</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Position Overview:
The Pharmacy Customer Service Representative I position provides customer service to members of multiple benefit plans by analyzing the caller&rsquo;s needs and by providing timely and accurate responses.  Utilizes numerous programs and resources to answer calls from members (Commercial and UMP), agents, providers, hospitals, pharmacists, PBM and Mail Order carriers regarding pharmacy benefits, eligibility, claims or other issues. This is a FT WFH position. 

Pay Range
$18.39 - $20.58 hourly, DOE.
*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:
https://j.brt.mv/jb.do?reqGK=27780728&refresh=true
 

Primary Functions:

Responds to questions and assists customers via telephone, virtual meeting platform or in person regarding their claim benefit questions from callers on both group and individual pharmacy products.  Provide solutions to problems, confirm eligibility, explain benefits and/or plan coverage. 
Repeatedly analyzes situations, communicates effectively, and provides accurate information in a fast-paced environment that includes dealing with escalated situations and upset people.
Applies mathematical skills to provide and determine correct benefit information.
Reviews, updates, and becomes familiar with new and revised benefit information, regulations, benefit information and claim processing procedures. 
Be familiar with drug names and recognize new drugs as they are released and added to the Moda drug list.
Requests claim adjustments required because of error or new information.  
Resolves and record complaints, appeals, and inquiries.
Contacts physicians, pharmacies and PBM&rsquo;s when necessary to answer questions and obtain or provide information.
Works with a culturally diverse population that can vary in age. 
Provides timely follow up and return calls when required.
Maintains departmental service standards related to phone calls.
Continues education and training through on-the-job communication with Supervisors and/or tenured Customer Representatives and by attending trainings scheduled by leadership.
Consults with Leadership on problem cases and interfaces with interdepartmental personnel in resolving escalation questions. 
Ability to maintain agreed upon work schedule and regularly work agreed upon shifts. 
Performs other duties as assigned.



Required Qualifications

High school education or equivalent experience.

1-2 years in a fast-paced customer service environment. A pharmacy or insurance setting preferred.

Type a minimum of 25-wpm on a computer keyboard

Ability to apply mathematical skills to provide and determine correct benefit information.

Proficient with Microsoft Office Applications, including Word and Excel and Outlook.

Strong verbal, written, and interpersonal communication skills.  Ability to interact professionally, patiently, and courteously with 
customers over the phone, in virtual meeting platforms and in person.

Proficiency in working thoughtfully and appropriately with a culturally, linguistically and ability diverse population.

Ability to work well under pressure; work with frequent interruptions, shifting priorities and quickly adapt to change.

Ability to work independently and as part of a team.

Ability to anticipate, meet and/or exceed customer needs and expectations in a professional manner.

Ability to come to work on time and on daily basis.

Maintain confidentiality and project a professional business image.

Ability to meet or exceed department standards and deadlines

Ability to multitask and efficiently utilize multiple (7-8) computer programs and packages at the same 

 
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 Claims, Marketing, Billing and Eligibility, Sales, Healthcare Services, and Provider Relations. Externally with members, providers, attorneys, brokers, government officials, PBM&rsquo;s and other insurance carriers.

 

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.]]></description>
      <pubDate>Mon, 06 Jul 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[LCSW, LPC, LMFT - Licensed Behavioral Health Care Coordinator I  - Portland, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27775722&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>c24c4976-efc1-450f-81fa-7471487b5e83</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Position Summary
Evaluates, authorizes, and manages behavioral health services to plan members.  Interacts with members, family, and care providers to coordinate quality care in clinically appropriate settings.  Applies clinical expertise with knowledge of resources and coverage, to promote effective, efficient treatment outcomes. 
This is a FT WFH role.
 
Pay Range
$71,990.85 - $91,000.00 annually. 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.
https://j.brt.mv/jb.do?reqGK=27775722&refresh=true
 

Benefits:

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


Required Skills, Experience & Education:

Active Oregon license as a behavioral health practitioner.
At least three years recent experience in behavioral health (mental health and/or chemical dependency) clinical settings. 
Excellent communication skills, both written and verbal, including ability to de-escalate and calm upset or distressed individuals.  
Excellent analytic, problem solving, and personal time/task management skills.  
Excellent memory retention and attention to detail.
Demonstrated ability to work well under pressure.
Ability to present oneself in a professional manner telephonically and in person.
Demonstrated ability to work across multiple computer applications.  
Type a minimum of 35 wpm on a computer keyboard.
Ability to come in to work on time and daily.
Maintain confidentiality and protect the privacy of member information.

Primary Functions:

Promotes positive treatment outcomes by helping members identify clinically appropriate services and making referrals for Behavioral Health Case Management. 
Assists members in navigating treatment options, understanding the authorization process, and accessing services.  
Evaluates treatment services for medical necessity and appropriate type of treatment and level of care.
Provides courteous and accurate customer service to members, family members and care providers.
Participates in researching articles outlining evidence-based practices for behavioral health treatment and participates in revising and developing Moda Behavioral Health medical necessity criteria.
Participates in Inter-Rater Reliability exercises with clinical team.
Provides clinical consultation to Health Coaches and Nurses within Healthcare Services.
Tracks and reports cost-savings obtained through medical necessity denials, negotiated discounts, reduced levels of care and lengths of stay.  
Completes Continuity of Care, Transition of Care, and Single Case Agreements. 
Negotiates pricing for Single Case Agreements with out-of-network facilities and providers when approved by the Moda Health Medical Director and allowed by member&rsquo;s plan
Prepares cases in a clear and concise manner for Moda Health Medical Director review.
Writes clear, individualized denial letters that reference specific criteria or handbook language. 
Completes provider searches for members, family members and Moda Healthcare Service teams.
Understands and follows Moda authorization and utilization review processes.
Ensures authorization determinations meet timeliness standards and are completed promptly and accurately.
Communicates clearly and assertively with providers and develops and maintains positive relationships with them.  
Completes documentation of contact with members and providers in a thorough, accurate and professional manner. 
Reports suspected fraud, waste, and abuse to Moda Health Special Investigation Unit.
Uses Moda systems (Benefit Tracker, Care Web, Content Manager, Facets) to give accurate information to members and providers. 
Resolves member and provider concerns before they become grievances/complaints, whenever possible.   
Works in a collaborative manner with providers and other Moda employees.
Responds to occasional crisis calls from members.  Assesses for safety, develops safety plans if needed, and provides treatment options.  
Perform other duties as assigned

 
Working Conditions & Contact with Others


Office environment with extensive close PC and keyboard work, constant sitting, and phone work. Extensive telephone work. Occasional driving for meetings outside the office Must be able to navigate multiple screens. Work in excess of 40 hours per week, including evenings and occasional weekends, to meet business need.


Internally with all departments. Externally with database vendor support, members, professional facilities, providers, and office staff.


 

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.]]></description>
      <pubDate>Mon, 29 Jun 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Quality Audit Specialist - Internal Applicants Only - Milwaukie, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27780411&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>3a2d86ff-b1f0-43a8-a21a-b18175683d2c</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Position Summary
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 FT hybrid position based in Milwaukie, Oregon.



Pay Range
$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.
https://j.brt.mv/jb.do?reqGK=27780411&refresh=true


Benefits:

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


Required Skills, Experience & Education:

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.



Primary Functions:

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 utilizing approved criteria and NCQA guidelines; identify interactions requiring immediate coaching, follow-up, or correction. 
Monitor and assess customer interactions across all channels to ensure compliance with established quality standards. 
Strive for accurate scoring by actively participating in calibration sessions, which help align evaluation standards across teams.
Develop and maintain QA scorecards that promote consistency, fairness, and alignment with company expectations.
Deliver actionable and constructive feedback to Representatives to support professional development and improve service quality.
Analyze QA results to identify knowledge or skill gaps and collaborate with leadership to develop targeted training initiatives.
Partner with leadership to create and implement initiatives that improve customer satisfaction and drive performance.
Maintain up-to-date knowledge of company policies, procedures, and products to ensure accurate and relevant evaluations.
Recommend process improvements to QA tools and methodologies to enhance overall efficiency and effectiveness.
Collaborate with leadership to regularly review and refine internal documentation.
Foster a positive, collaborative work environment and demonstrate a strong commitment to teamwork and service excellence.
Assist with the development and training of new Quality Audit Specialists and support team calibration.
Transcribe calls as requested.
Perform other duties as assigned.



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 Claims, Sales and Account Services, Membership Accounting, Benefit Configuration, Information Services, Customer Service, and Provider Relations. Externally with members, providers, other insurers, and agents.


 

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.
 
#INTONLY]]></description>
      <pubDate>Mon, 29 Jun 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Medical Claims COB Processor I - Milwaukie, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27778911&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>54c99484-4d57-4546-9504-e13e97500548</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Position Summary
Investigates and processes COB (Coordination of Benefits) COB claims, and completes all necessary steps needed for claims processing. Assists in customer service inquiries regarding contractual and administrative policies and applies excellent customer service when a phone call is needed to complete a COB claim. This is a FT WFH role. 


Pay Range
$18.39 - $20.58 hourly, DOE.
*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.
https://j.brt.mv/jb.do?reqGK=27778911&refresh=true



Benefits:

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


Required Skills, Experience & Education:

High School diploma or equivalent.
Minimum of 6 months medical claim processing or customer service dealing with all types of plans/claims and consistently exceeding performance levels.
Professional and effective written and verbal communication skills.
10-key proficiency of 135 spm net on a computer numeric keypad.
Type a minimum of 35 wpm net on a computer keyboard.
Ability to maintain balanced performance, which consistently exceeds minimum expectations in areas of production and quality.
Good analytical, problem solving, decision making and detail-oriented skills with ability to shift priorities as needed.
Good organizational abilities and the ability to handle a variety of functions.
Ability to multitask and work well under pressure and meet timelines.
Ability to maintain confidentiality internally and externally and project a professional business image always.
Proficiency in claims processing systems; Facets, Word, and Excel.
Knowledge and understanding of Moda Health administrative policies affecting claims and customer service.  
Demonstrates work habits that include Moda Health standards of attendance and punctuality, as well as flexibility. 


Primary Functions:

Communicates via telephone with claimants, policyholders, providers, and other insurance carriers.
Review, analyze, and resolve claims through the utilization of available resources for complex claims. 
Analyze and apply plan concepts to claims that include deductible, coinsurance, copay, COB, and out of pocket, etc.
Examines claims to determine if further investigation is needed from other departments and routes claims appropriately through the system. 
Release claims by deadline to meet Company, state regulations, contractual agreements, and group performance guarantee standards.
Maintain discretion and confidentiality in compliance with federal, state, and departmental guidelines.
Reviews Policy and Procedures (P&P) for process instructions to ensure accurate and efficient claims processing as well as providing suggestions for potential process improvements. 
Monitors and maintains unit inventory.
Thoroughly documents actions as required by internal procedure and market conduct guidelines. 
Assists internal departments with correcting eligibility and programming issues as needed.
Responds and follows up using FACETS, Content Manager and E-mail.
Provides back up to Medical Claims when requested. 
Performs all job functions with a high degree of discretion and confidentiality in compliance with federal, state, and departmental confidentiality guidelines.
Perform other duties as assigned.
Work weekly Itinerary reports
Ability to maintain balanced performance, which consistently exceeds expectations in areas of production and quality.
Work on other new COB related functions as needed.
Copy Dual Moda claims
Work Vision COB claims
Review and submit Overpayment spreadsheet
Complete updates
Process Medicare COB claims
Adjust COB claims
Work Clinical Edit (CE) COB claims as needed
Identify and route claims requiring further investigation within the system.

 
Working Conditions & Contact with Others:

Works internally with the customer service, membership accounting, and appeals departments. Works externally to support client needs.  Must be able to navigate multiple screens. Be able to work extra hours during the work week and occasional Saturdays to meet business needs. 
Office environment with extensive close PC and keyboard work, constant sitting, and phone work. Must be able to navigate multiple screens. Work in excess of 37.5 hours per week, including evenings and occasional weekends, to meet business need.


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.]]></description>
      <pubDate>Thu, 25 Jun 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Patient Care Advocate, Pharmacy Technician (Ardon Health) - Portland, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27780004&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>b247cb2d-d722-4121-bb0a-9ae3fcf5c0fe</guid>
      <description><![CDATA[This position is employed through Ardon Health, a subsidiary of Moda Health. 
 
As we continue to grow, we are seeking a Patient Care Advocate to join our award-winning specialty pharmacy team. 
About Ardon Health
At Ardon, we are passionate about our mission to inspire people and improve lives through the delivery of high-quality, compassionate healthcare services. Our innovative work environment in Portland, Oregon, centers around uplifting collaboration with our employees as we care for patients. Our commitment to cultivating talent and fostering growth within our organization keeps Ardon ranked among the top 100 companies to work for in Oregon. 
*Recognized as a Top Workplace by the Oregonian in 2021, 2022, 2023, and 2024*
Our specialty pharmacy
Our state-of-the-art specialty pharmacy provides medications that are often used to treat complex or rare conditions. We deliver services to enhance the patient experience within the comfort of their home. We remove barriers to care and provide patients with the education, clinical care and supportive services they need on their treatment journey. We work to build trusted relationships and to be a resource where patients can turn for help.
What it&rsquo;s like to work with our team
Our progressive work environment embodies the notion that life is meant to be shared and lived well, through hard work, compassion, and camaraderie. Together, we enjoy team meals and celebrate events and company milestones. Employees like to relax in our lounge equipped with amenities that promote wellness and fun. We volunteer to support patient advocacy organizations within our community. Our employee-run DEI Group is dedicated to diversity and inclusion. 
To learn more about our team and what we do, watch our video at https://vimeo.com/320864889.
Join us!
Do you want a dynamic career opportunity where you can make a difference? Explore the potential of your pharmacy experience in an elevated role.
We are recruiting a Patient Care Advocate to join our team of health care professionals. As a Patient Care Advocate, you will be responsible for providing exceptional customer service to specialty pharmacy program members by responding to telephone calls and providing outreach.  
 

Job type: Full-time (on-site)

Salary Range: $22.88 - $25.75 hourly, depending on experience
 

Benefits: 

Competitive pay
Flexible PTO and paid company holidays
Medical, dental, vision, disability and life insurance 
401K match

 
Essential functions and activities:
1.    Acts as liaison between company, patients, and physician&rsquo;s office.
2.    Responsible for reviewing new prescriptions and making sure all necessary information including insurance verification is available to process orders.
3.    Explains all company programs and services to patients and physician&rsquo;s office staff.
4.    Communicates with patients as needed based on prescription refills and refers any medication or illness related questions or concerns to a board licensed healthcare professional, including but not limited to nurses, pharmacists, and supervised pharmacy interns.
5.    Responsible for scheduling prescription refills utilizing the pharmacy software.
6.    Maintains documentation of calls to and from patients.
7.    Contacts patients to schedule deliveries, confirm addresses, inform of any co-payments involved, and notify of payment responsibilities.
8.    Refers under- or uninsured patients to appropriate patient assistance programs and helps with applications.
9.    Communicates patient status to physician&rsquo;s offices/clinics.
10.  Maintains patient confidentiality.
11.  Utilizes operating systems and tools to help manage patient therapy and refill compliance.
12.  Maintains active Oregon license. Informs supervisor within 1 business day (and Oregon Board of Pharmacy within 10 days) of any arrests, convictions, suspected or known violations of law, or any other conduct that might affect or has affected license status. Reports to Oregon Board of Pharmacy within 15 days any changes to name, residence address, or employment.
13.  Regular attendance in conformance with the standards, which may be revised from time to time, is essential to the successful performance of this position. 
14.  Actively participates and provides support as needed to leadership and quality program staff to ensure activities related to the company&rsquo;s quality management program and quality improvement activities maintain priority focus and are effectively executed. This may include but is not limited to activities that promote objective and systematic measurement, monitoring, and evaluation of services and defined Quality Improvement Projects (QIPs) that may result from such efforts.
15.  Complies with the company&rsquo;s Human Resources policies, Employee Handbook, Code of Conduct, and all department policies and procedures, including protecting confidential company, employee, and customer information; attending work punctually and regularly; and adhering to good safety practices in all activities.
16.  Performs other duties and responsibilities as assigned.
 
Additional/non-essential functions and activities

Performs or supports administrative tasks as needed


 
Position specifications:
1        Education and experience
a.    Required:
                      i.        High school diploma or GED.  
                     ii.        Active Oregon Pharmacy Technician License. A Certified Oregon Pharmacy Technician License will be required prior to expiration of existing Oregon license or as required by the Oregon board of Pharmacy. 
b.    Preferred:
                      i.        Six months to one year of experience in a medical office or pharmacy setting.
                     ii.        Prior work experience in a customer service setting
2.        Physical and mental functions and activities
a.    Must be able to multi-task and work in a fast-paced environment.
b.    Must have excellent verbal, written, and interpersonal communication skills.
c.    Must be able to express oneself, detect, perceive, observe, and assess information exchanged in a variety of communication methods.
d.    Must be able to demonstrate proficiency with computer applications.
e.    Must be able to work independently as well as part of a team.
3.        Working conditions
a.    Work is performed primarily at a desk, with extensive keyboard and telephone work in a stationary position. 
b.    Business needs may occasionally require work in excess of 40 hours per week, including work outside of the standard work week. 
4.        Contact with others: 
a.    Internally with Ardon employees across multiple departments.
b.    Externally with providers, payers, and plans. 


Our ideal candidate has:

Strong communication and interpersonal skills.
Ability to effectively collaborate in a team setting.
Proficiency in standard workplace software and/or information management applications.
Prior experience working in a pharmacy or healthcare setting.
Ability to navigate computer applications.
Ability to work in a fast-paced environment.

 
Ardon Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual identification or orientation, national origin, marital status, disability, veteran status, or any other status protected by law.]]></description>
      <pubDate>Mon, 22 Jun 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Software Engineer - Portland, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27776988&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>76985796-76b0-4303-8e9a-3dd0cc0e9729</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Position Summary
We are seeking a SQL Software Engineer in our IT department. This position will be responsible for designing, coding, testing, maintaining, and implementing back-end Microsoft SQL Server T-SQL objects and SSIS packages used to process inbound and outbound transactions with our business partners with a strong focus on stored procedures; work with Business Analysts and other teammates to understand business requirements/processes to provide technical and system support; create technical design documents. This is a FT WFH position. 

Pay Range
$87,013.56 - $113,113.41 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.
https://j.brt.mv/jb.do?reqGK=27776988&refresh=true 
 

Benefits:

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


Required Skills, Experience & Education:

Bachelor&rsquo;s degree in a relevant field (Computer Science, Software Engineering, Information Services, or similar) with 3+ years&rsquo; experience; or 7+ years of relevant SQL programming experience.
Deep understanding of relational database design, development, and support (MS SQL Server T-SQL preferred)
Experience in complex database objects in T-SQL and/or PLSQL
Experience in systems analysis
Knowledge of basic database security practices.
Strong interpersonal communication skills.
Strong analytical thinking and adept at problem-solving.
Ability to work well under pressure, work with frequent interruptions, and shifting priorities.
Understanding of SDLC methodologies.
 Maintain confidentiality and project a professional business image.
 Ability to come into work on time daily.

 
Preferred Skills, Experience & Education:

Experience with cloud technologies (e.g., Microsoft Fabric) is a plus. 
Experience in healthcare systems is a plus; Facets experience preferred.

 
Primary Functions:

Maintain existing stored procedures and systems.
Design and develop new stored procedures and systems as part of the implementation of new business requirements.
Work with clients to identify and understand requirements to satisfy business processes\requirements.
Develop detailed technical design specifications, which include file layouts, program functions and job flow.
Implementing and testing database design and functionality, and tuning for performance
Develop and maintain documentation of all objects associated with a project.
Ensure that new systems integrate into current batch cycles.
Participate in 24x7 on-call rotation.
Assist with training and technical support of others on staff.
Maintain a detailed working knowledge of the business unit(s) being supported.
Perform other duties as assigned.

 
Working Conditions:

On-call status, office environment with extensive close PC and keyboard work, constant sitting, and phone work. Must be able to navigate multiple screens. Work in excess of 40 hours per week, including evenings and occasional weekends, to meet business need.
Internally with supported departments.  Externally with software vendors, customers, and technical staff from groups and state agencies

 
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.]]></description>
      <pubDate>Mon, 22 Jun 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Data Engineer I, II - Portland, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27777149&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>861f7594-425b-4998-97a2-d75a34fbd33f</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Position Summary
The Data Engineer role on the Data Science Team (DST) is responsible for designing, maintaining, and enhancing data integration pipelines that support the Enterprise Data Warehouse (EDW) and downstream analytics. This role supports the existing on premises data environment while actively contributing to cloud modernization initiatives, including the adoption of modern data transformation and cloud data warehouse technologies such as dbt and Snowflake. This is a FT WFH position. 

Pay Range
$78,911.43 - $110,265.00 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. Position level is based on qualifications & experience. 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.


https://j.brt.mv/jb.do?reqGK=27777149&refresh=true 






 




Benefits:

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


Required Skills, Experience & Education:

Bachelor's Degree in a related field or equivalent practical experience preferred
1 - 5 years of experience working with large datasets in relational databases and SQL-based data analytic platforms. Experience with SQL Server and modern SQL-based cloud data warehouses, e.g. Snowflake, BigQuery, Redshift, etc.) is preferred.
1 - 5 years of hands-on SQL development experience, including writing complex queries, stored procedures, and performance tuning.
1 - 5 years of practical experience developing and supporting data pipelines and transformations using SSIS, SQL Agent, Azure Data Factory, and/or Airflow. Exposure to modern cloud-based transformation tools such as dbt or similar is preferred.
Experience supporting on-premises data warehouse environments and contributing to future cloud modernization efforts, including assisting with migrations from on-premises SQL Server&ndash;based platforms to Snowflake or similar cloud technologies. 
Solid understanding of data management principles, relational data structures, and data modeling, with the ability to apply best practices in both on-premises and modern SQL-based cloud data warehouses. 
Demonstrated analytical skills and ability to contribute to data driven solutions that address real business problems, with guidance from senior engineers when needed. 
Working knowledge of Agile development methodologies and participation in collaborative, team-based delivery models. 
Exposure to DevOps practices using tools such as Azure DevOps (CI/CD, work item tracking, GIT version control, Pull Requests) is desirable.
Experience working with business intelligence and reporting tools such as SAS Enterprise Guide, Power BI or SSRS, including supporting downstream analytics and reporting users. 
Familiarity with programming or scripting languages such as Python, R, or Java is a plus. 
Experience with healthcare data is strongly preferred. 

 
Primary Functions:

Design, develop, test, and maintain ETL/ELT pipelines that ingest data from multiple internal and external source systems into the Enterprise Data Warehouse (EDW).
Automate, maintain and enhance existing data pipelines to ensure reliability, performance, and scalability, while implementing incremental improvements as part of ongoing cloud modernization efforts.
Contribute to data platform modernization initiatives, including assisting with migrations to cloud-based infrastructure and adoption of modern data tools and practices.
Develop, implement, and support data quality checks, validation processes, and monitoring to ensure data accuracy and consistency.
Build and support modern, enterprise-grade data pipelines and models under the guidance of senior engineers to enable adoption of next-generation data architecture.
Collaborate with cross-functional teams to understand data and reporting requirements and provide ongoing support for data infrastructure needs.
Support the Data Science team by implementing and maintaining data solutions that enable advanced analytics and machine learning cases.
Participate collaboratively in Enterprise Data Warehousing, Business Intelligence, and other data management initiatives, including code reviews and documentation.
Perform other duties as assigned.

 
Working Conditions:

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.
Experience in healthcare systems is a plus; Facets experience preferred.

 
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.]]></description>
      <pubDate>Fri, 19 Jun 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[RN Program Manager, Care Management - Portland, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27779726&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>3d433057-445c-43ea-8d10-2ed3aa7dbc0a</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Position Summary
The Manager of Care Management provides operational and clinical leadership for care management programs, including care coordination, complex case management, and population health initiatives. This role ensures the delivery of high-quality, member-centered care while optimizing clinical outcomes, access, and total cost of care. The Manager serves as a clinical and operational leader, partnering across the organization and with external stakeholders to design, implement, and continuously improve care management strategies aligned with regulatory requirements, quality metrics, and value-based care goals. This is a FT hybrid position based in Portland, Oregon. 



Pay Range
 $94,799.21 - $120,867.41 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.

Please fill out an application on our company page, linked below, to be considered for this position.
https://j.brt.mv/jb.do?reqGK=27779726&refresh=true


Benefits:

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


Required Skills, Experience & Education:

Bachelor&rsquo;s degree in Nursing (BSN) or related clinical field required; Master&rsquo;s degree preferred.

Minimum of 5 years of clinical or healthcare delivery experience.

At least 3 years of experience in care management, case management, utilization management, or population health&mdash;preferably within a health plan.

Minimum of 2&ndash;3 years of leadership or supervisory experience.

Active, unrestricted clinical license (RN or other relevant healthcare professional) in the State of Oregon required.

Strong clinical knowledge and application of evidence-based guidelines.

Demonstrated leadership and team development skills.

Experience driving operational and clinical transformation initiatives.

Proficiency in interpreting and leveraging healthcare data and financial metrics.

Strong project management and organizational skills.


 
Primary Functions:

Collaborate in the development, implementation, evaluation, and continuous improvement of clinical programs to support Moda&rsquo;s mission, strategic goals, regulatory requirements, and accreditation standards
Lead day-to-day operations of care management programs, including care coordination, case management, and disease management.
Provide coaching, mentorship, and performance management to a multidisciplinary team.
Foster a culture of accountability, continuous improvement, and member-centered care.
Ensure appropriate staffing models, workflow design, and resource allocation to meet program demands.
Serve as a clinical subject matter expert to guide evidence-based care management practices.
Ensure adherence to clinical guidelines, regulatory standards, and accreditation requirements (e.g., CMS, NCQA).
Monitor and improve program performance related to quality outcomes, member experience, and utilization.
Develop and execute care management strategies aligned with organizational goals, including:

Value-based care
Population health management
Health equity initiatives


Identify trends in utilization, gaps in care, and opportunities to improve access and outcomes.
Lead quality improvement initiatives and implement action plans to address performance gaps.
Partner with analytics teams to identify data needs and interpret clinical, financial, and operational performance data.
Use data insights to inform program design, decision-making, and resource prioritization.
Oversee reporting of care management outcomes, including dashboards and ad hoc analyses.
Ensure compliance with all applicable state, federal, and contractual requirements.
Oversee accurate and timely documentation and reporting, including submissions to NCQA and other regulatory bodies.
Develop, implement, and maintain departmental policies, procedures, and standard work.
Performs other duties as assigned 

 
Working Conditions:

Office environment.
Extensive keyboard, telephone work and meetings.  
Extensive sitting.
Hybrid clinical, operational, and strategic role requiring both analytical and interpersonal expertise.
Frequent collaboration with internal departments and external providers, partners, and vendors.

 
 
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.]]></description>
      <pubDate>Wed, 17 Jun 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Social Health Member Navigator - Portland, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27779720&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>697175a6-71a6-4a6b-8fbc-9ecb1e872007</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Position Summary
This position provides support to the EOCCO Health Related Social Needs (HRSN) Operations team by assisting in the monitoring and review of Health-Related Social Needs coverage requests. In addition, this position completes referrals to case management, and HRSN service providers. This position fulfills the contractual obligation with the Oregon Health Authority (OHA) regarding collaboration between health plans and community partners in overseeing the utilization of services by all members, particularly those that make up the prioritized populations identified in various Oregon Administrative Rulings.  This is a FT hybrid position based in Portland, Oregon. 


Pay Range
$54,668.32 - $68,340.67 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.

Please fill out an application on our company page, linked below, to be considered for this position.
https://j.brt.mv/jb.do?reqGK=27779720&refresh=true

 
Benefits:

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

 
Required Skills, Experience & Education:

Bachelor&rsquo;s degree or equivalent.
2+ years of experience in healthcare, public health, community-based organizations, including work in or with rural or underserved communities.
Experience in a medical office, social work, case management and/or utilization management preferred.
Traditional Health Worker certification or intent to complete within 6 months of hire date.
Proven history of strong attention to detail and thoroughness.
Detailed understanding of HRSN and Medicaid complexities.
Proven history of strong organizational skills and ability to meet established deadlines.
Ability to work well under pressure in a complex and rapidly changing environment.
Ability to communicate customers and members interests and needs to internal project teammates, to improve work flows and processes.
Strong presentation skills.
Type a minimum of 60 wpm net on a computer keyboard.
Strong statistical, analytical, and problem-solving skills.
Excellent oral, written, and interpersonal communication skills, and the ability to interact professionally, patiently, and courteously with customers over the phone, and in person.
Ability to maintain confidentiality and present a positive and professional image in the communities we serve.
Demonstrates proficiency in desktop application software including email, word processing, spreadsheets and creating presentations.

 
 
Primary Functions:

Conducts eligibility screenings for HRSN requests which includes outreach to members, providers, or other entities.
Determines the most effective utilization of HRSN funds by reviewing requests against state established criteria.
Reviews requests from outside entities, triages member needs, and directs to care coordination.
Manages HRSN requests to ensure members are offered and receive medically necessary services.  
Ensures documentation in the HRSN needs assessment is thorough for all member-related service requests and meets Oregon Health Authority requirements.
Provides education to members and providers regarding Health-Related Social Needs, including how to request, criteria for coverage, availability of resources, and case management services.
Consult with the HRSN Manager or RN on complex cases.
Utilizes multiple business accounts for ordering and tracking items approved through HRSN benefits.
Remains current on all Oregon Health Authority guidance regarding health-related social needs benefits
Utilizes the Moda Health core systems (CCA, Facets, benefit tracker, etc) for eligibility and benefit verification, documentation of contact with providers and members.
Provides data entry for HRSN reporting
Conducts post authorization referrals and assignments to HRSN service providers.  
Provides additional outreach to members as needed to offer support services or connection to other resources.
Completes documentation to support compliance deliverables related to reporting throughout the year.
Send proper correspondence to providers, members, and other departments to identify support persons and notify EOCCO designated care coordination staff.
Ensure adherence to the Health Insurance Portability and Accountability Act (HIPPA) and other regulatory guidelines including privacy and security.
Must maintain 98% quality audit scores regarding care planning documentation.
Identifies problems and researches alternative solutions.
Works with other team members to meet member needs related to care coordination.
Completes other duties and special projects as assigned
Maintain accurate patient note entry in Moda systems to improve communication amongst internal and external partners.


Working Conditions & Contact with Others

Hybrid office environment 3 days per week or more as needed with extensive close PC and keyboard work, consistent sitting must be able to navigate multiple screens. Work in excess of 40 hours per week, including evenings and occasional weekends, to meet business need.
Multiple internal departments including, but not limited to: Healthcare Services, Case Management and Claims. Externally with Members, HRSN service providers, community-based organization and other health systems across service area.  

 
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 and Daniel McGinnis via our humanresources@modahealth.com email.]]></description>
      <pubDate>Wed, 17 Jun 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Dental CS Rep I (***) - Portland, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27779460&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>0f0d5965-7bec-4b1a-92c7-08c99f688bc1</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Position Summary
Provide customer service to members of multiple benefit plans by analyzing the caller&rsquo;s needs and by providing timely and accurate responses. Answer calls from policyholders, agents, members, providers, and others regarding benefits, eligibility, claims, premiums, or other issues. This is a full-time work from home position. 
 
Pay Range
$18.39- $20.58 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.
https://j.brt.mv/jb.do?reqGK=27779460&refresh=true 

Benefits:

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


Required Skills, Experience & Education:

High school diploma or equivalent. 
Practical knowledge of medical or dental terminology preferred but not required.
Knowledge of diagnosis and procedure coding preferred but not required.
Prior customer service experience, other related experience such as medical/dental office experience, or customer support experience. 
Strong reading, verbal and written communication skills. Ability to interact professionally, patiently, and courteously with customers over the phone. 
Good analytical, problem solving and decision-making skills. 
10-key proficiency of 105 kspm net on a computer numeric keypad. 
Type a minimum of 35 wpm net on computer keyboard.
High speed internet (cable or fiber) 
Must be proficient with Microsoft Office applications with the ability to open and navigate multiple windows at the same time.
Ability to achieve and maintain quality standards.
Ability to work well and independently under pressure in a complex and rapidly changing environment. 
Ability to meet the attendance and punctuality policy of Moda Health.
Ability to remain focused and on task in a work from home environment.  
Maintain confidentiality and project a professional business presence and appearance. 
Ability to repeatedly analyze situations and communicate effectively in a fast-paced environment that includes dealing with escalating queries and concerns. 
Ability to organize and remain up to date on changing and new information.   
Ability to troubleshoot and follow protocols for reporting internet or technological issues.

Primary Functions:

Answer a high volume of inbound phone calls regarding dental claims, benefits, premiums, and eligibility involving employer groups, Oregon Health Plan (OHP) and Individual products. Provide solutions to problems, confirm eligibility, explain benefits and/or plan coverage. 
Provide accurate information in a professional manner. 
Apply mathematical skills to determine correct benefit information and premium amounts for Individual plans. 
Exercise judgement, initiative, and discretion in confidential and sensitive matters. 
Perform related duties: 

Follow HIPAA guidelines to protect member health information.
Document all aspects of a call in a clear and concise manner. 
Keep up to date on new and revised benefit information, claim processing procedures, or system updates. 
Gather banking details so monthly premium for members on Individual plans can be collected.
Identify and request claim adjustments when necessary. 
Resolve and record complaints, appeals, and inquiries. 
Contact providers, other insurance companies or state agencies when necessary to answer questions and obtain or provide information. 
Provide timely follow-up and return calls within department guidelines. 
Answer calls within service level time.


Perform other duties as assigned by Manager/Supervisor/ Lead. 

 
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 multiple departments. Externally with members, providers, attorneys, policyholders, brokers, government officials, and other insurance carriers.


 
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.]]></description>
      <pubDate>Sun, 14 Jun 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Medical CS Rep I (***) - Portland, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27779497&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>309f39d7-da35-4e8d-8e34-0812f9207d35</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Position Summary
Provides phone customer service to members of multiple benefit plans by analyzing caller&rsquo;s needs and providing timely and accurate responses.  Answers calls from policyholders, members, agents, providers, hospitals, pharmacists and others regarding a variety a wide variety of issues and questions related to a members health plan. These can include explaining benefits, claims processing and other details of the plan.  This is a full-time work from home position. 
 
Pay Range
$18.39- $20.58 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.
https://j.brt.mv/jb.do?reqGK=27779497&refresh=true
Benefits:

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


Required Skills, Experience & Education:

High school diploma or equivalent. 
Practical knowledge of medical terminology desired. 
Knowledge of diagnosis and procedure coding desired. 
Claim processing experience or prior customer service experience or other related experience such as medical/dental office experience. 
Excellent oral and written communication skills. Ability to interact professionally, patiently, and courteously with customers over the phone.  
Good analytical, problem solving and decision-making skills. 
10-key proficiency of 105 spm net on a computer numeric keypad. 
Type a minimum of 25 wpm net on a computer keyboard.
High speed internet (cable or fiber) 
Must be proficient with Microsoft Office applications with the ability open and navigate multiple windows at the same time.
Ability to achieve and maintain quality and quantity standards.
Ability to work well under pressure in a complex and rapidly changing environment. 
Ability to be at work on time and daily. 
Maintain confidentiality and project a professional business presence. 
Ability to repeatedly analyze situations and communicate effectively in a fast-paced environment that includes dealing with angry people.
Ability to organize and remain up to date on changing and new information.


Primary Functions:

Answers 50+ calls a day regarding claims and benefit questions from callers on both group and individual plans. Provide solutions to problems, confirm eligibility, verify premium&rsquo;s and collect payments for members on individual plans, explain benefits and/or plan coverage. 
Ability to repeatedly analyze situations, communicate effectively, in a fast-paced environment that includes dealing with frustrated or angry callers. 
Provide accurate information in a professional manner. 
Apply mathematical skills to determine correct benefit information and premium amounts for Individual plans. 
Exercise judgement, initiative, and discretion in confidential and sensitive manners. 
Performs related duties:  
Review, update and become familiar with new and revised benefit information or claim processing procedures. 
Review and explain any authorization requirements of the plan using on-line tools available.
Update and enter primary care physician selections if required by member&rsquo;s plan.
Gather banking details so monthly premium for members on Individual plans can be collected. 
Request claim adjustments required because of error in processing or any new information that has been received.  
Resolve and record complaints, appeals, and inquiries. 
Complete provider searches using available on-line web-based systems to assist members in finding providers that meet their needs and that of that plan. 
Contact physicians, dentists, hospitals, and other providers when necessary to answer questions and obtain or provide information. 
Provide timely follow up and return calls when these are required. 
Document all aspects of a call in a clear and concise manner.
Answer calls within service level time. 
Other duties and projects as assigned by Manager/Supervisor/Lead.

 
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 Medical Claims, Healthcare Services, Marketing, Membership Accounting, Provider Relations, Pharmacy and Case Management. Externally with members, providers, attorneys, policyholders, brokers, government officials, and other insurance carriers. 


 
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.]]></description>
      <pubDate>Sun, 14 Jun 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Lead Medical Claims Auditor I - Milwaukie, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27779206&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>a64778fc-c9d5-4c58-9bb3-aa1df993f4ac</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Position Summary
Provides backup support to Supervisor for reports, questions policy development and maintenance, and identification/implementation of process improvements.  Oversees department workflow and provides assignments as needed.  Assists with external audits. This is a FT WFH position.
 
Pay Range
$20.88- $23.49 hourly, DOE.
**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.
https://j.brt.mv/jb.do?reqGK=27770685&refresh=true

Benefits:

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

 
Requirements:

High School diploma or equivalent. 
Minimum of 2 years of experience as a Claims Auditor. 
Excellent reading, verbal and written communication skills and ability to interact professionally, patiently, and courteously. 
Strong analytical, problem solving, and decision-making skills with demonstrated ability to handle and resolve complaints, correct errors, and resolve departmental issues in accordance with Moda contracts and company policies. 
10-key proficiency of 105 wpm net on a computer numeric keypad. 
Type a minimum of 25 wpm net on a computer keyboard. 
Ability to work well under pressure in a complex and rapidly changing environment. 
Ability to maintain confidentiality and project a professional business image. 
Working knowledge of all plan types, contract and policies affecting claims and customer service. 
Proficiency in all internal claims systems and Microsoft Office applications. 
Demonstrated ability to consistently organize work and time to meet deadlines and complete work in a timely manner. 
Ability to come to work on time and daily. 
Ability to work with frequent interruptions and demonstrate professional leadership. 
Demonstrated strong, effective, and diplomatic interpersonal skills with employees of all levels, and ability to participate effectively as a team player. 
Maintain confidentiality and project a professional business presence and appearance. 
Be flexible and accepting of change.  


Primary Functions:

Provide back up and support to supervisor of unit.  Includes monitoring of assignments and overtime, evaluating performance, training, communicating policy to staff, and answering questions from Claims Auditors and Reinsurance Specialists.  
Ability to analyze situations and communicate effectively in a fast-paced environment that includes a wide variety of job duties. 
Provide accurate information in a professional manner. 
Exercise judgment, initiative, and discretion in confidential and sensitive matters. 
Assists in planning, organizing, and directing the activities and workflow of the department. 
Responsible for quality and continuous improvement within the job scope. 
Answer inquiries from other departments to include: Customer Service, Claims, Billing & Eligibility, Accounting, and HealthCare Services.  
Perform related duties: 

Communicate concerns, issues, and ideas for improvement to Supervisor 
Develop, document, and maintain department policies and procedures. 
Claim adjustments and file reviews. 
Assist with External Audits 
Monitor and maintain unit spreadsheets. 
Assist with Reinsurance, Auditing and Claims Processing as needed. 
Contact physicians, dentists, hospitals, and other providers when necessary to answer questions and obtain or provide information. 
Review, update and become familiar with new and revised benefit information or claim processing policies and procedures. 
Assist in monitoring large projects received from other departments. 


Other duties as assigned.

 
Contact with Others
Internally with Claims, Customer Service, HealthCare Services, Billing & Eligibility, Benefit Configuration, Accounting, Underwriting, Corporate, Information Services, Corporate Data and Professional Relations. Externally with Providers, Members, Vendors, Insurance companies, Reinsurance carriers, Case Management organizations and Brokers. 


Working Conditions
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. 
 

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.]]></description>
      <pubDate>Tue, 09 Jun 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Medical Provider Configuration Analyst I - Portland, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27779167&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>e15c5e16-8e03-4385-90d8-6e7d73f314db</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Position Summary
The Medical Provider Configuration Analyst I is responsible for performing configuration activities, assisting in research and resolution of configuration issues, and supporting system testing and projects. This position focuses on learning and applying provider configuration principles in Facets or similar systems. This is a FT WFH position.
 
Pay Range
$23.34 - $26.26 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.
https://j.brt.mv/jb.do?reqGK=27779167&refresh=true
 
Benefits:

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

 
Required Skills, Experience & Education:

Bachelor's degree or equivalent combination of education and experience.
0-2 years of experience in health insurance or a related field.
Proficient in Microsoft Office, especially Excel; eagerness to learn advanced Excel functions for data analysis.
Basic SQL knowledge.
Basic knowledge of healthcare provider data and claims processing preferred.
Strong analytical and critical thinking skills with the ability to apply business rules to configuration tasks.
Basic understanding of data integrity and quality assurance practices.
Ability to follow standards for data validation and spreadsheet preparation.
Strong attention to detail, organizational skills, and ability to manage multiple priorities effectively.
Ability to learn new concepts quickly and adapt to changing processes.
Good written and verbal communication skills.
Ability to work well in a remote team environment.
Maintain a professional appearance and demeanor in all internal and external interactions.


Primary Functions:

Analyze and configure provider information in the system following established procedures and business rules.
Perform data analysis and validation using Excel, including formulas, data sorting and VLOOKUP functions.
Prepare and validate provider rosters for Robotic Automation System (RAS) processing.
Identify and resolve provider configuration errors using SQL.
Report data issues to the lead or supervisor.
Participate in projects with guidance from senior team members.
Assist in documenting configuration processes and updating department manuals.
Conduct quality reviews of configuration work and submit for timely auditing.
Attend training to improve skills and knowledge.
Follow quality standards and help with quality checks.
Perform other duties as assigned.

 
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.]]></description>
      <pubDate>Mon, 08 Jun 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Medical Claims Processor I - Milwaukie, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27778986&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>1d69bb48-8f78-4f9a-a65c-edc72f3f57db</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Position Summary
Responsible for utilizing resources efficiently for the accurate and timely entry, review, and resolution of simple to moderately complex medical claims in accordance with policies, procedures, and guidelines as outlined by the company. This is a FT WFH role. 


Pay Range
$17.34 - $19.41 hourly, DOE.
*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.
https://j.brt.mv/jb.do?reqGK=27778986&refresh=true



Benefits:

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


Required Skills, Experience & Education:

High School diploma or equivalent
6-12 months data entry or medical office experience preferred
10-key proficiency of 135 spm
Type a minimum of 35 wpm
Knowledge of medical terminology, CPT codes and ICD-9/10 codes preferred
Demonstrates work habits that include punctuality, organization, and flexibility
Ability to maintain balanced performance in areas of production and quality
Analytical reasoning and flexibility
Professional and effective written and verbal communication skills
Experience with Facets platform a plus
Identify all the duties and responsibilities


Primary Functions:

Enters claims data into system while interpreting coding and understanding medical terminology in relation to diagnosis and procedures.
Review, analyze, and resolve claims through the utilization of available resources for moderately complex claims.
Analyze and apply plan concepts to claims that include deductible, coinsurance, copay, out of pocket, etc.
Examines claims to determine if further investigation is needed from other departments and routes claims appropriately through the system.
Adjudication of claims to achieve quality and production standards applicable to this position.
Release claims by deadline to meet company, state regulations, contractual agreements, and group performance guarantee standards.
Reviews Policies and Procedures (P&P&rsquo;S) for process instructions to ensure accurate and efficient claims processing as well as providing suggestions for potential process improvements.
Performs all job functions with a high degree of discretion and confidentiality in compliance with federal, state, and departmental confidentiality guidelines.
Flexible schedule that may include working 5 hours of overtime on pre-determined Saturdays to meet business needs.   Moda&rsquo;s standard workweek is a 37.5 hour work week.


Working Conditions & Contact with Others:

Office environment with extensive close PC and keyboard work with constant sitting. Must be able to navigate multiple screens. Flexible schedule that may include working 5 hours of overtime on pre-determined Saturdays to meet business needs.  Moda&rsquo;s standard workweek is a 37.5 hour work week.
Works internally with the customer service, membership accounting, and appeals departments. Works externally to support client needs.


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.]]></description>
      <pubDate>Thu, 04 Jun 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Workforce Management Analyst I - Portland, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27779000&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>9c9f6f82-3370-4b10-86a3-7a45c1fff8e0</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Position Summary
Supports Contact Center staff to achieve operational and service delivery goals as they relate to the WFM System.  Responsible for daily workforce planning, scheduling, and performance/trend reporting. This is a FT WFH position. 

Pay Range
$23.34 - $26.26 hourly (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.
https://j.brt.mv/jb.do?reqGK=27779000&refresh=true
 

Benefits:

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


Required Skills, Experience & Education:

High school diploma or equivalent.
One year of experience in contact center and WFM support background preferred.
Ability to communicate effectively, both written and verbally, required.
Proficiency in MS Word and Excel required.
Excellent math skills required.
Basic understanding of Call Center Management Systems (WFM and ACD) preferred.
Ability to solve problems quickly.
Ability to maintain confidentiality required.
Must always project a professional business image.
Strong analytical, organizational, and detail orientation skills required.
Ability to multi-task and work well under pressure.
Regular and punctual attendance required.
Must be willing to work overtime occasionally if necessary.
Must be self-motivated.
Must work effectively with minimal supervision.
Experience conducting data analysis and ad-hoc reporting preferred.
Must show ability to learn new applications, tools, and processes.

 
Primary Functions:

Retrieve and record CS absences and schedule changes and notify stakeholders as appropriate.
Create schedule assignments for Customer Service Agents.
Adjust schedules daily due to unplanned absences and anticipated service demand.
Monitor real-time schedule adherence and notify leadership of anomalies as appropriate.
Ensure WFM Schedule simulations are completed multiple times each day.
Grant WFM permissions as appropriate for new hires.
Train new hires on schedule process and Agent Web Station usage.
Act as primary support for Contact Center WFM System.
Resolve WFM related inquiries and escalations from internal customers.
Proactively recommend scheduling of discretionary activities such as training, meetings, etc.
Proactively recommend overtime or changes to schedules to ensure appropriate staffing.
Create and update documentation and resource materials as needed.
Disseminate reports and information to stakeholders as appropriate.
Perform other duties as assigned.

 
Working Conditions:

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 all customer service and occasionally with IT department.  Externally with outsource vendor partner and occasionally with NICE support personnel.

 
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.]]></description>
      <pubDate>Thu, 04 Jun 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Inpatient Claims Processor I - Milwaukie, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27778909&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>41f367f7-1592-4605-a2ad-be48c12cca7b</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Position Summary
Responsible for timely and accurate payment of Commercial and Medicaid inpatient hospital claims.  Answer internal questions from various departments and respond to correspondence from providers when necessary. This is a FT WFH role. 


Pay Range
$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.
https://j.brt.mv/jb.do?reqGK=27778909&refresh=true
 

Benefits:

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

 
Required Skills, Experience & Education:

High School diploma or equivalent.
1-2 years medical claims processing experience.
10-key proficiency of 135 wpm.
Type a minimum of 35 wpm.
Knowledge of medical terminology, CPT codes and ICD-10 codes.
Strong verbal, written, and interpersonal communication skills.
Analytical, problem solving and organizational skills.
Ability to work well under pressure.
Maintain confidentiality and project a professional business image
Ability to maintain balanced performance in areas of production and quality.


Primary Functions:

Review, process and adjust Commercial and Medicaid inpatient claims.  
Review claims data, interpreting coding and understanding medical terminology in relation to diagnosis and procedures.
Review, analyze, price, and resolve inpatient claims through the utilization of available resources for moderate to complex inpatient claims, adjustments, and file reviews.    
Process Commercial and Medicaid inpatient claims for all types of contracts (e.g., DRG, per diem, case rate, % of CMS). 
Analyze and apply plan concepts to claims that include deductible, coinsurance, copay out of pocket, etc.  
Examine claims to determine if further investigation is needed from other departments and routes claims appropriately through the system.  
Contact providers and other outside sources for additional information.
Adjudicate claims to achieve quality and production standards applicable to the position.
Release claims by deadlines to meet company, state regulations, contractual agreements, and group performance guarantee standards.
Review Policy and Procedures (P&P) for process instructions to ensure accurate and efficient claims processing as well as providing suggestions for potential process improvements.
Perform all job functions with a high degree of discretion and confidentiality in compliance with federal, state, and departmental confidentiality guidelines.
Perform other duties as assigned.


Working Conditions & Contact with Others

Office environment with extensive close PC and keyboard work, constant sitting, and phone work. Must be able to navigate multiple screens. Work in excess of 37.5 hours per week, including evenings and occasional weekends, to meet business need.
Works internally with Healthcare Services, Membership Accounting, Customer Service, Hospital Auditors, Provider Correspondence, and Professional Relations. Works externally with providers and vendors.  
 

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 and Danielle Baker via our humanresources@modahealth.com email.]]></description>
      <pubDate>Wed, 03 Jun 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Medical Claims Clerk I - Milwaukie, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27778907&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>7e8c03b3-88e0-4726-ac3b-193f65008466</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Position Summary
The Medical Claims Clerk provides clerical and administrative support to the Medical Claims Department. The position ensures that documents, inquiries, and records are handled accurately to support consistent and compliant claim processing. This is a FT on-site position based in Milwaukie, Oregon.

Pay Range
$17.34    $18.92 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.
https://j.brt.mv/jb.do?reqGK=27778907&refresh=true



Benefits:

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

Required Skills, Experience & Education:

6-12 months office experience.
Typing ability of 30 wpm net.
Proficiency with Microsoft Office applications and the ability to learn internal systems including Facets and Content Manager.
Knowledge of or the ability to learn Moda plan benefits and claim processing guidelines.
Strong organizational skills and attention to detail.
Strong verbal, written, and interpersonal communication skills.
Ability to work with frequent interruptions and shifting priorities.
Ability to lift up to 50 lbs.
Ability to work onsite and maintain confidentiality.


Primary Functions:

Sort and distribute mail and faxes to appropriate teams and departments. 
Scan and index mail using designated printers and software, and prepare documents for submission to Imaging according to established workflows.
Review provider inquiries to identify the correct plan benefits, claim processing guidelines, and required documentation needed for resolution.
Analyze provider types and recurring issues and identify claim processing trends and patterns. Recommend process improvements when appropriate.
Enter bulk provider inquiries accurately into the Moda Health operating system and ensure completeness and data integrity.
Manage assigned Content Manager image queues and work baskets and prioritize tasks based on urgency, service levels, and departmental guidelines.
Provide daily inventory counts and reporting to support workflow management and productivity monitoring.
Maintain organized electronic and physical records, following HIPAA requirements and internal security protocols.
Communicate with internal teams to clarify documentation needs, resolve discrepancies, or support claim review processes.
Participate in continuous improvement efforts, including updates to documentation, workflows, and training materials.
Perform other duties as assigned.

 
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 Claims, Imaging, Facilities and other departments as required. Externally with members, vendors, or providers as directed. 
 

 
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 and Danielle Baker via our humanresources@modahealth.com email.]]></description>
      <pubDate>Wed, 03 Jun 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Provider Correspond Coord I - Milwaukie, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27778789&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>ef8bd35b-1458-4d96-a581-ae49c994cf8a</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together. 

Job Summary:
Moda Health is seeking a Provider Correspondence Coordinator in our Medical Claims department. This position researches and provides written response to medical provider correspondence and appeals regarding claim edits, processing, authorizations and medical necessity reviews; researches and provides written response to medical inquiries regarding benefit and plan design issues. This is a FT WFH position. 
 
Pay Range
$19.43 - $21.86 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.
https://j.brt.mv/jb.do?reqGK=27778789&refresh=true


Benefits:

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


Primary Functions:


Responds to provider appeals and related correspondence.
Interacts with physician/provider offices by letter or phone to gather additional   information regarding claim disputes.
Performs a total claim review to determine over/underpayment on problem claims.
Works with Claims Support to adjust previously processed claims. 
Documents accurately in Facets regarding outcome of claims disputes.
Meets the departments established standards for case completion.
Other duties as assigned.


 
Required Skills & Experience:

High School education or equivalency.
6 months - 2 years&rsquo; medical claims processing or customer service experience.
Strong reading, writing and verbal communication skills
Good analytical, problem solving, decision making and organizational skills.
10 key proficiency of 105 spm net on a computer numeric keypad.
Type a minimum of 35 wpm net on a computer keyboard.
Ability to work under pressure and meet mandated time frames.
Ability to read and interpret contracts and apply Moda Health policies and procedures.
Ability to communicate positively, patiently, and courteously with callers.
Proficiency in Facets, Content Manager and EBT.
Proficiency in computer applications such as Word and Excel.
Ability to maintain confidentiality and project a professional business image.

 
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 Claims, Customer Service, Healthcare Services, Membership Accounting, Information Technology, and Professional Relations. Externally with Providers, Members, Vendors, and Insurance companies.  


 
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 and Danielle Baker via our humanresources@modahealth.com email.]]></description>
      <pubDate>Tue, 02 Jun 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Medical Claims Auditor I - Milwaukie, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27778811&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>9e7c6378-7fa0-46f6-8e3a-05e4ef358fa8</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Position Summary
Provides accurate quality assurance auditing of post-payment claims to determine correct adjudication and benefit application. Completes complex reports and provide feedback on accuracy. This is a FT WFH position.
 
Pay Range
$18.39 - $20.58 hourly, DOE.
**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.
https://j.brt.mv/jb.do?reqGK=27778811&refresh=true
 
 
Benefits:

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

 
Requirements:

High school diploma or equivalent. 
6 months &ndash; 2 years claim processing or customer service dealing with all types of plans/claims consistently exceeding performance levels. 
Strong reading, writing, and verbal communication skills. 
Good analytical, problem solving, decision making, organizational and detail-oriented skills with ability to shift priorities.
10-key proficiency on a computer numeric keypad. 
Type a minimum of 25 wpm net on a numeric keyboard. 
Good organizational skills, ability to work well under pressure and ability to handle a variety of functions to meet timelines. 
Ability to maintain confidentiality and project a professional business image. 
Ability to start work on time and daily. 
Proficiency in Facets claims processing applications and Benefit Tracker. 
Knowledge of the reporting tool system and Employer Online Services is helpful. 
Knowledge and understanding of medical claims processing administrative policies affecting claims and customer service. 
Computer proficiency in Microsoft office applications. 


Primary Functions:

Audit claims daily statistically valid sampling method, using prescriber audit criteria. Performs simple adjustments as necessary. 
Conduct in-depth claims audits on performance groups, as well as focus audits for specifically identified situations on a scheduled basis. 
Compiles and publishes reports based on the results of claim audits as well as processor productivity on a weekly, monthly, and quarterly basis. 
Run report in PBIRS to conduct audits. 
Prepares required monthly and/or quarterly reports for specific group performance guarantee, production, and accuracy results. 
Identify trends from audit results and recommend improvements to increase overall quality. 
Assists in the investigation and response to performance group inquiries. 
Other duties/tasks as assigned.

 
Contact with Others
Internally with Claims, Sales & Account Services, Membership Accounting, Benefit Configuration, Information Services, Customer Service and Provider Relations. 


Working Conditions
Remote work environment with extensive close PC and keyboard work, constant sitting, and phone work. Must be able to navigate multiple screens. Work in excess of standard work week, including evenings and occasional weekends, to meet business need.
 

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.]]></description>
      <pubDate>Tue, 02 Jun 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[​​Sr Cloud & Infrastructure Engineer​ - Portland, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27770304&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>27a52816-4a8c-4359-b99e-0c6d7b8799f3</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Position Summary
The Sr Cloud & Infrastructure Engineer is a senior-level individual contributor responsible for engineering and supporting Moda&rsquo;s hybrid infrastructure services. These services span network connectivity, enterprise voice and telecommunications, and data center engineering and operations. This role ensures secure, reliable, and resilient services across on-premises data centers, colocation environments, and cloud-connected infrastructure. Key responsibilities include monitoring, incident response, disaster recovery, and maintaining operational readiness. The position also includes minor oversight of power and space management for data centers and remote facilities to maintain uptime for mission-critical systems. This is a FT hybrid position based in Portland, Oregon. 

Pay Range
$93,829.88 - $121,982.98 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.
https://j.brt.mv/jb.do?reqGK=27770304&refresh=true
 

Benefits:

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


Required Skills, Experience & Education:

Bachelor&rsquo;s degree in Computer Science, Engineering, or related field, or equivalent experience.  
6&ndash;8 years in a senior infrastructure/network systems role within a medium to large enterprise environment.  
Strong understanding of networking, Windows server environments, and infrastructure fundamentals; able to diagnose performance and reliability issues using appropriate tools and methods.  
Experience with enterprise platforms including Microsoft Admin Center, Teams, Exchange, SharePoint, Active Directory/LDAP/Azure Entra ID, firewalls, file systems, networks (Juniper), VPN, virtualization (Nutanix, VMware), and remote access (Citrix).  
Working knowledge of data center operations, including coordination with power, cooling, space constraints, and vendor/colocation processes.  
Working knowledge of enterprise voice, telecommunications, and UCaaS systems, and the operational practices required to sustain reliable service across multiple sites.  
Demonstrated ability to solve problems quickly, automate processes, and work under pressure with frequent interruptions and shifting priorities.  
Strong verbal, written, and interpersonal communication skills; able to document clearly and coordinate across teams and vendors.  
Ability to travel infrequently as needed. 
Ability to lift 20 lbs. 

 
Primary Functions:

Design, implement, and troubleshoot network and infrastructure architectures, including LAN/WAN, secure remote access, and connections between on-premises and cloud services. 
Partner with architecture, engineering, and administration teams to implement and sustain secure connectivity patterns (private connectivity, segmented networks, routing/firewall integration, and service dependencies). 
Optimize Windows server and infrastructure environments to surpass service-level expectations and improve reliability and performance. 
Use observability tools to isolate weaknesses, analyze trends, and provide actionable metrics. 
Maintain accurate technical documentation and improve procedures to meet or exceed audit requirements. 
Plan and execute maintenance activities (patching, upgrades, lifecycle updates), coordinate implementation windows, and validate service health post-change. 
Develop and maintain automation scripts (PowerShell, Python) to reduce manual effort and improve consistency. 
Support enterprise backup, monitoring, and storage readiness by coordinating with platform owners and ensuring cross-team dependencies during incidents and maintenance events. 
Engineer and support enterprise voice and telecom services (UCaaS integrations, Microsoft Teams). 
Partner with stakeholders to gather requirements, deliver voice and telecom improvements, and evaluate platforms and vendor solutions, providing recommendations aligned with enterprise standards. 
Design cabling infrastructure to support primary, remote, and data center facilities. 
Provide hands-on support for data center environments, including rack/stack, cabling and cross-connect coordination, hardware troubleshooting, and vendor engagement. 
Coordinate data center operational dependencies (power, cooling, space, physical access, and maintenance windows) in partnership with facilities, colocation providers, and internal stakeholders. 
Assist with capacity and resiliency planning by identifying power/space constraints, raising risks early, and recommending practical mitigations. 
Provide senior-level technical guidance and mentorship to peers and junior staff; collaborate effectively with architecture, engineering, security, and external vendors. 
Participate in 7x24 on-call rotation for critical incidents and supporting time-sensitive operational events. 
Perform other duties as assigned. 

 
Working Conditions:

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. Available for on-call and critical response team work.  
Internally with all departments including senior executives. Externally with vendors and various stakeholders. 

 
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.]]></description>
      <pubDate>Mon, 18 May 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Manager, Pharmacy Business Development - Portland, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27777532&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>86b9e3f0-7cde-4ede-8716-5e10cc07da2d</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Position Summary
We are seeking a Manager of Pharmacy Business Development with a focus on industry relations. The domain expertise to be successful in this role requires foundational clinical pharmacy experience, accompanied by a high degree of business acumen, and an interest and passion for partnering closely with pharmaceutical and biotechnology companies, and other vendor partners who engage in contracting opportunities such as rebate management, and clinical programs. Overall, this position is responsible for development of strategic formulary approaches for the management of medications across the medical and pharmacy benefits, driving to low net cost medication utilization. This position includes reviewing rebate initiatives for medications covered under the pharmacy and medical benefits, across various lines of business including commercial, Exchange, Medicare and Managed Medicaid. The role includes facilitating or supporting the implementation of projects or activities with both external and internal stakeholders, and articulating this value as necessary. The ideal candidate resides near or within commuting distance of our Portland, Oregon office to support a hybrid work arrangement, however, remote status will also be considered. 

Pay Range
$136,786.84 - $174,406.91 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.
https://j.brt.mv/jb.do?reqGK=27766011&refresh=true



Benefits:

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


Required Skills, Experience & Education:

Five years of pharmacy and healthcare experience, including clinical, operational, compliance and navigating complex regulated environments. 
Bachelor&rsquo;s degree in healthcare, life sciences, public health, pharmacy or related field; equivalent experience considered.
Three to five years of managed care experience.
Past supervisory experience managing a team.
Experience with Commercial, Medicare, and/or Medicaid lines of business.
Experience managing contracts, particularly with biopharmaceutical manufacturers and other pharmacy vendors.
Technical understanding of pharmacy claims processing information and systems.
Strong analytical skills and business acumen.
Ability to communicate and present technical information appropriate for the audience.
Ability to work independently and collaborate cross-functionally with various stakeholders.
Project management skills and the ability to plan and execute projects as assigned.
Commitment to service, organization values, and professionalism.
Ability to maintain confidentiality and project a professional business image.
Works well under pressure with frequent interruptions and shifting priorities.
Ability to work independently.
Proficient with Microsoft Office applications such as Word, Excel, Outlook, and PowerPoint.

 
Primary Functions:

Lead industry relations and rebate strategies for medical and pharmacy benefit medications, and new and emerging therapies, across all lines of business.
Oversee all rebate partners and lead evaluations of new potential partners.
Identify and negotiate direct contracts with biopharmaceutical partners.
Identify, manage, and assess the value of unique vendor partnerships to advance pharmacy programs, including drug information resources, medical management organizations, digital therapeutics, and point of service solutions.
Responsible for ensuring compliance with rebate contracts, rebate terms within client contracts, and contracts held with other vendor partners.
Lead rebate modeling and optimize rebate scenarios and bid selections based on client specific goals and strategies.
Oversee pipeline developments, including market events and material changes to therapeutic categories, for new and emerging therapies, specialty, and traditional medications, and keeps internal and external stakeholders apprised of such events. Develops educational materials as needed.
Leads custom formulary rebate offerings and recommendations for downstream clients.
In collaboration with other pharmacy leaders, develop enterprise-wide industry relations strategy.
Oversee, develop and manage Moda&rsquo;s Industry Relations team.
Lead rebate offerings for existing therapeutic strategies which support ongoing formulary performance, but also identify new opportunities either as contracting changes or new market entrants are FDA-approved.
Work closely with vendor partners (PBM, medical management companies, others) on policy or formulary changes driven by cost analysis, including rebate considerations or contracting.
Support and/or lead client-facing presentations within industry relations as necessary.
Responsible for information gathering with legal and/or regulatory teams to understand impact to current formulary strategies, with financial implications, to anticipate or plan for any potential compliance driven update due to changes in existing, or new and emerging states of business.   
Monitor, anticipate changes, and prepare for pipeline and market events.
Develop concise, applicable, comprehensive, and timely communiques as assigned for members, providers, internal, or external stakeholders.
Provide clinical support services that intersect industry relations or business development, including but not limited to benefit design, formulary analysis, drug information, P&T participation, client support, and drug utilization management.
Contribute, update, and maintain policies and procedures related to industry relations. 
Complete significant projects and performs all other related duties as assigned.
Follow the company HR policies, Code of Conduct, and all department policies and procedures including protecting confidential company, employee, and customer information. 


Working Conditions & Contact with Others

Remote, office environment, and/or hybrid with extensive close PC and keyboard work, and constant sitting. Work in excess of 40 hours per week, including evenings and occasional weekends, to meet business needs. May require occasional travel to conferences or offsite business meetings.
Internally with Clinical Pharmacy, Analytics, Marketing, Sales & Account Services, Actuary & Underwriting, Healthcare Services, Medicare and Medicaid Programs, Benefits, Legal, Regulatory Affairs, and Compliance. Externally with PBM, medical management vendor, pharmaceutical and biotechnology manufacturers, consultants and benefit managers, clients, providers, and pharmacists.

 
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.]]></description>
      <pubDate>Wed, 13 May 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Imaging Data Entry Clerk - Milwaukie, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27777455&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>1bfa5e19-02ee-467f-b723-24cdf17b611a</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Position Summary
Receive, track, sort, prepare, and route all incoming mail to various departments. Operate and maintain office equipment, including Opex, Omation, and multiple scanners. Prepare batches for in-house scanning or external processing with Symbeo while maintaining strict turnaround times. Enter member, group and provider information into the system for processing. Prepare daily inventory reports and assist with training on rotational tasks when necessary. Provide coverage for the receptionist desk and phone when required. This is a FT hybrid position based in Milwaukie, Oregon. 

Pay Range
$17.34 - $17.85 hourly, DOE.
**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.
https://j.brt.mv/jb.do?reqGK=27777455&refresh=true 

Benefits:

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

 Location:

10505 SE 17th Ave, Portland, OR 97222

 Requirements:

High school diploma or equivalent.
At least 6-12 months experience in a production environment preferred.
Ability to lift 20+ pounds and work in a fast-paced, physical role. 
Ability to embrace process improvements and work well in a team-oriented environment.
Proficiency with Microsoft Office applications.
Typing ability of 35 wpm.
10-key proficiency of 135 kspm.
Proficient with prioritizing tasks and completing them with high accuracy and speed. 
Ability to work well under pressure, with frequent interruptions and shifting priorities.
Demonstrates effective reading, writing and oral communication skills.
Ability to meet production and quality standards for various types of work and documents.
Skilled in handling multiple tasks.


Primary Functions:

Handle all incoming mail, including inter-office, packages, letters, claims, and certified mail.
Sort and prepare medical and dental claims for scanning and vendor handling.
Locate, store, rescan, return, or forward claims for further review.
Scan paper x-rays.
Lift and pull stacks of claims, bins, and mail trays.
Track outgoing and incoming claims batches between Moda and Symbeo to ensure compliance and all records are accurate and accounted for.
Ensure timely processing of all mail, including scanning, batching, and indexing. Prioritize Medicaid, Medicare, and appeal-related mail to maintain compliance with federal and state regulations. 
Prepare and batch specialized sorting tasks like medical correspondence, member appeals, and prescription claims.
Prepare and distribute daily inventory to Claims Management teams.
Keep the mail distribution area clean and organized.
Maintain office equipment, including Omation and Opex automatic mail-opening machines and multiple scanners.
Enter claims data accurately using Moda systems and ensuring correct member and provider selection while reassigning claims based on dental claims processing guidelines.  
May write and mail letters to members and providers.
Provide relief coverage for the reception desk.
Perform other duties as assigned.


Contact with Others
Internally with various departments.  Externally with members, providers, brokers, etc., when covering reception desk.

Working Conditions
Office environment with extensive close PC and keyboard work, constant sitting, and phone work. Must be able to navigate multiple screens. Work in excess of 40 hours per week, including evenings and occasional weekends, to meet business need.
 

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.]]></description>
      <pubDate>Tue, 12 May 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[CS Tech Support Specialist I (***) - Milwaukie, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27777469&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>6998ead4-6d16-46e8-a9d1-4ef0deb9619a</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Position Summary
The CS Tech Support Specialist I position serves provides Customer Service and Technical Support to internal and external clients through multiple contact channels for Medical, Dental, Pharmacy, Individual Membership Account, MyModa, Benefit Tracker Administration and Maintenance. Administers Moda online Customer Service programs, including program application procedures, internet security protocol for external users and records maintenance. Shares administration of MyModa, eBill and Benefit Tracker functionality. The primary role of this position is to provide professional, prompt and accurate technical support to all Internal and External Customers. This is FT WFH role.


Pay Range
$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.
https://j.brt.mv/jb.do?reqGK=27777469&refresh=true


Benefits:

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


Required Skills, Experience & Education:

High school diploma or equivalent.
6-12 months experience as a Customer Service Rep Level II, consistently exceeding level of performance or equivalent work experience or equivalent work experience.
10 key proficiency of 135 spm net on a computer numeric keypad.
Typing ability of 25 wpm net.
Computer proficiency with multiple systems, browsers, Moda software (Microsoft Office applications, Facets, Content Manager, Excel, EBT, online chat) and updates.
Prior experience or basic understanding of claims processing, membership accounting, medical/dental/pharmacy plan benefits and/or other related experience handling Customer Service escalations, Technical Support or Online Chat. 
Strong time management, planning and organization skills with ability to prioritized and manage changing priorities.
Ability to handle multiple tasks simultaneously and adapt to change.
 Ability to work well under pressure in a complex and rapidly changing environment.
Ability to anticipate, identify, analyze and resolve conflict and problems.
Ability to listen and understand information verbally and in writing.
Well-developed verbal and written communication skills with the ability to actively listen, interact professionally, patiently and courteously with clients on the phone, in person, through email, social media or online chat.
Strong analytical and critical thinking, problem solving, decision-making skills, with attention to detail.
Maintain confidentiality and project professional business presence and appearance.
Ability to comply with company rules and policies and maintain attendance above company standards.
Able to embrace process improvements and works well in a team oriented environment.
Demonstrated ability to handle difficult calls and benefit issues with little assistance and provide accurate information in a fast paced environment.
Experience working in a collaborative and fast-paced team environment.
Demonstrated real time problem-solving skills and ability to prioritize multiple tasks based on urgency and importance.
Help customers troubleshoot issues they encounter and provide actionable tips to resolve.
Demonstrated outstanding attention to detail, ownership, and follow-through.
Consistent record of achieving individual and team metrics.
Excellent professional written & oral communication skills.
Passion for technology and willingness to learn new skills.
Ability to navigate multiple computer programs in a fast pace multi-tasking environment.
Empathy/compassion for working with senior, disabled, low income populations.
Ability to work extra hours and participate in overtime as needed.
Ability to work with multiple Pharmacy, Dental and Medical (Individual, Specialized, Medical Intake, EOCCO) applications and contacts types at the same time.



Primary Functions:

Responsible for interpreting needs/concerns, determining best course of action, troubleshoot, and identify system issues and solutions. Guide users through features and functionalities.
Respond to customer queries in a timely and accurate way, via phone, email, chat or social media.
Quickly identify problems, form solutions, and execute step-by-step troubleshooting procedures.
Support customers across different platforms; phone, email, chat or social media and ability to trouble shoot multiple devices (desktop pc, tablet, phones, browsers, hardware, OS)
Resolve issues efficiently from start to finish, set appropriate expectations and follow through; and/or escalate support tickets to leadership when escalation is required.
Analyzing and reporting system issues and trends in a timely manner. Provide customer feedback received to leadership.
Develop access to registrants&rsquo; passwords and log-in data so when questions are received a prompt answer can be provided.
Ability to repeatedly analyze situations and communicate effectively in a fast paced environment that includes dealing with angry people.
Exercise judgment, initiative, and discretion in confidential and sensitive manners.
Consistently follow the correct process and procedure with each line of business and contact method being used.
Maintain forms necessary for new external provider and employer users.
Responsible for handling all requests received for Certificate of Coverage and CCC letters
Responds to Benefit Tracker, MyModa, EBT and External Secure email user questions (via telephone, email, or correspondence). 
Monitor customer complaints on social media and reach out to provide assistance.
Respond to email inquiries received from multiple mailboxes across all lines of business: MyModa, Medical, Dental, Pharmacy, EBT and Individual Membership Accounting, within established turnaround times.
Open and Submit service tickets for possible Benefit Tracker, eBill and MyModa programming changes, system issues and trending topics (following established reporting policy).
Review, update and become familiar with new and revised benefit information or claim processing procedures.
Contact providers, group administrators and agents when necessary to answer questions and obtain or provide information.
Support and assist Medical, Dental, Pharmacy and Individual Membership administrator questions.
Maintain detailed records of daily interactions with customers, reported issues, and completed solutions along with any further actions required of customer service or Moda
Communicate clearly and effectively with end users, colleagues, and management to quickly resolve issues and ensure customer satisfaction.
Other duties as assigned



Working Conditions & Contact with Others

Office environment with extensive close PC and keyboard work, constant sitting, and phone work. Must be able to navigate multiple screens. Work in excess of 37.5 hours per week, including evenings and occasional weekends, to meet business need.
Answer inquiries received through phone calls, emails, online chat, social media and outbound text from subscribers, members, Agents, Brokers, Providers/Facilities, Dentists, Pharmacies, Group Administrators and multiple internal departments.

 

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.]]></description>
      <pubDate>Tue, 12 May 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Sr Software Engineer - Portland, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27776990&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>3f23a820-8c8c-4e1e-8e58-b81aaefff70a</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Position Summary
Under limited supervision or on a self-directed basis, responsible for the major systems supporting the various departments.  Design, code, test, maintain and implement programs and systems.  Work with client departments to develop business partnerships and to understand business requirements/processes to provide technical and system support.  Provide training, mentoring and technical support to staff and clients. This is a FT WFH position. 

Pay Range
$95,706.48 - $124,422.64 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.
https://j.brt.mv/jb.do?reqGK=27776990&refresh=true 
 

Benefits:

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


Required Skills, Experience & Education:

Bachelor&rsquo;s degree or equivalent specializing in computer science or other technical discipline. 
At least 10 years of computer programming experience or knowledge of key technologies used by the company. 
Outstanding systems analysis and programming skills with mastery in multiple relevant computer languages. Project management skills for medium to large projects. 
Outstanding verbal, written and interpersonal communication skills. 
Outstanding analytical, problem solving, decision making, organizational, and detail orientation skills. 
Ability to work well under pressure with all projects, both large and small, work with frequent interruptions, and shifting priorities. 
Maintain confidentiality and project a professional business image. 
Ability to come into work on time and on a daily basis. 

 
Primary Functions:

Maintain existing programs and systems. 
Design and develop new programs and systems as part of the implementation of application systems. 
Work extensively with clients to identify requirements and satisfy client business processes. Develop detailed design specifications, which include file layouts, program functions and job flow. 
Develop and maintain documentation of all objects associated with a project. Ensure that objects are named according to established naming standards. 
Ensure that new systems integrate into current production cycles, assign file names according to naming standards. 
Assist with training and technical support of staff and clients. 
Maintain a business partnership and detailed working knowledge of functions performed by the user department being supported. 
Other duties as assigned.

 
Working Conditions:

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 all departments.  Externally with software vendors, customers, and technical staff from groups and state agencies.

 
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.]]></description>
      <pubDate>Wed, 06 May 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Government Programs Appeal Coordinator I  - Milwaukie, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27776277&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>0ede7cd8-1a34-4903-b7cd-2d042ffc015e</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Job Summary:
Investigate and respond to medical, pharmacy and dental grievances, complaints, appeals, and inquiries for the organization.  Respond to outside regulatory inquiries as needed. This position is in Government Programs. 
This is a FT WFH position.
 
Pay Range
$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.
https://j.brt.mv/jb.do?reqGK=27776277&refresh=true


Benefits:

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


Primary Functions:


Research all grievances, complaints, correspondence, and appeals. Perform a complete review at each stage of the complaint/appeal process and ensure the appropriate documentation, including claim review to determine over/underpayment.
Respond in writing (or orally when appropriate) to requests, grievances, complaints, and appeals within the mandated timeframes. 
Ability to maintain a full caseload.
Communicate effectively and appropriately with other departments to ensure complete and fair reviews of grievances, complaints, and appeals. 
Communicate by letter and/or telephone with members, claimants, independent review entities, attorneys, and providers regarding claims/policies on Moda Health benefit plans. 
Interpret contracts (evidence of coverage; handbooks) and determine actions required. 
Respond to independent review entity requests for member case files within the stipulated timelines and ensure appropriate documentation required for reporting. Staff may also be required to respond to DFR requests or attend Medicaid hearings as a representative of the company.
Work with appropriate departments to effectuate decisions. 
Meets the departments established production and accuracy standards for case completion. 
Accurately document in system the outcome of grievances, complaints, and appeals.
Other duties as assigned


 
Required Skills & Experience:

High School diploma or equivalent. 

6 months to 2 years of experience of medical/dental claims processor or customer service preferred.   
Demonstrated knowledge of CMS rules for Medicare and Medicaid grievance, complaint and appeal processes preferred. 
Knowledge and understanding of complaint and appeal procedures preferred. 


Ability to interpret benefit contracts and/or Moda Health administrative policies, products, and business lines. 
Demonstrated strong reading, verbal, written and interpersonal communication skills. 
Demonstrated initiative, analytical, problem solving, and organizational skills. 
10 key proficiency of 105 kspm on a numeric keypad. 
Type a minimum of 25 wpm accurately on a computer keyboard. 
Demonstrated proficiency in computer applications such as Word, Excel, or other core operating systems. 
Ability to work well under pressure and meet deadlines while completing a high volume of work. 
Ability to maintain confidentiality and project a professional business image. 
Ability to adhere to Moda Health attendance policies and work assigned schedule which may include some overtime and occasional weekend and Holiday coverage. 
Ability to communicate positively, patiently, and courteously. 

 
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.


Inside the company including with Medicare Programs, Medicaid Services, Professional Relations and Contracting, Customer Service, Membership Accounting, Claims, Legal Services, Regulatory, Compliance, Privacy and Healthcare Services teams. Outside the company with Members, Provider Offices, Independent Review Entities, Attorneys, and contracted vendors.


 
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 and Danielle Baker via our humanresources@modahealth.com email.]]></description>
      <pubDate>Sun, 26 Apr 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Alaska Health Coach (NBC-HWC) - Anchorage, AK]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27776002&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>dc7c4086-d90b-4026-95ab-cef891857e69</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Position Summary
Moda Health Coaches develop and implement behavior-based coaching programs and provide healthcare navigation support, including condition-specific disease management, for Moda members. This includes Moda 360 members and various participating employer groups, such as the City of Portland. Coaches collaborate with internal and external healthcare service teams, vendor point solutions, and community-based organizations to ensure coordinated, continuous care. This is a FT WFH role based in Alaska. 


Pay Range
$70,810.77 - $88,518.85 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.
https://j.brt.mv/jb.do?reqGK=27776002&refresh=true


Benefits:

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


Required Skills, Experience & Education:

Associate degree, preferably in a healthcare-related field. 
Completion of a training program approved by the National Board for Health and Wellness Coaching (NBHWC) and eligibility for board certification. 
Specialty credential such as NBC-HWC, RDN, LCSW, or LPC is a plus. 
At least one (1) year of experience in a health coaching-related field preferred; experience within a health insurance or similar healthcare setting is also helpful. 
Experience working with individuals managing conditions such as diabetes, obesity, asthma, hypertension, heart disease, cancer, behavioral health, respiratory illness, or musculoskeletal conditions is preferred. 
Solid understanding of health behavior change theories and their practical application. 
Excellent communication, interpersonal, and presentation skills across diverse populations. 
Strong cultural competence and the ability to integrate Diversity, Equity, and Inclusion (DEI) principles into coaching and communication. 
Ability to work independently and collaboratively in a team-based environment. 
Proficiency in Microsoft Office and the ability to learn proprietary systems and databases. 
Proficiency in a second language is preferred. 
Strong commitment to maintaining confidentiality. 

 
 
Primary Functions:

Provide one-on-one coaching to members managing or at risk for chronic health conditions through multiple communication channels (virtual, phone, email, mail) to support disease prevention and self-management. 
Use evidence-based guidelines to educate, support, and empower members in setting and achieving SMART health goals while building their capacity for self-management. 
Conduct initial assessments of member health, including wellness vision, motivation, readiness to change, and health history. Document progress, behavior changes, and care gap closures in accordance with organizational policies and procedures. 
Partner with internal and external healthcare teams to achieve Triple Aim goals: improving the member experience, improving outcomes, and reducing avoidable costs. 
Maintain up-to-date knowledge of vendor health management programs and refer members as appropriate. 
Perform other duties as assigned. 


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 and Danielle Baker via our humanresources@modahealth.com email.]]></description>
      <pubDate>Wed, 22 Apr 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Membership Accounting Specialist I (***) - Portland, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27775933&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>59073a93-dec1-437a-ae50-498cc0c68efc</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Position Summary
This position is responsible for timely, accurate data entry and maintenance of Medical and Dental member eligibility, member and billing reconciliation, customer service to assigned groups or accounts, and generation of ID cards for all Moda Health and BHS lines of business including; Individual, Medicare, Medicaid, (CCO and DCO) and Employer Group customers of all sizes (ASO and Fully insured) COBRA and TPA accounts. The ideal candidate resides near or within commuting distance of our Portland, Oregon office to support a hybrid work arrangement, however, remote status will also be considered. 

Pay Range
$18.39 - $20.58 hourly, DOE. 
*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
https://j.brt.mv/jb.do?reqGK=27775933&refresh=true
 
Benefits:

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


Required Skills, Experience, & Education:

High school diploma or equivalent.
 Previous experience and/or knowledge of Facets preferred.
A minimum of 3 years&rsquo; experience preferred in fast paced business, data entry, customer service, enrollment, billing, and reconciliation environment.
Computer proficiency with Microsoft Office applications particularly Excel and Word.
Ten key proficiency of 135 kpm on a computer numeric keypad/calculator preferred.
Typing proficiency of 25 wpm preferred.
Strong analytical, problem solving, decision making, organizational and detail-oriented skills.
Strong verbal, written and interpersonal communication skills.
Ability to be courteous, patient and communicate with Moda Health and BHS members, Moda Health and BHS employees and Employer Groups in a positive and productive manner.
Maintain confidentiality and project a professional business image.


Primary Functions:

Responsible for eligibility and enrollment procedures daily via paper enrollment, electronic file, web-based transactions, email enrollments, and sending welcome packet to our new members for all Moda and BHS products and lines of business.
Ensure the accuracy and timeliness of entering enrollments within the department, Employer Groups, State and Federal standards depending on Product and Line of Business.
Responsible for following delinquency policy and procedures to ensure both compliance and timely receipt of administrative fees and premiums. 
Ensures all member, premium and administrative fees are reconciled monthly to the penny.
Maintains confidentiality of all information related to members, employer groups, employees, and as appropriate, other information.
Highly motivated and able to take initiative, demonstrated ability to identify and solve problems.
Responds to all internal and external customer inquiries regarding enrollments, ID cards and attends customer meetings as requested by Sales and Account Services.
Responsible to log and track enrollment applications in excel and give monthly reports to the Supervisor and the groups that shows a running balance on total enrollments received; enrollments entered into our system; voids and pending.
Accurately enter COB, COBRA and Pre-Existing for timely and accurate claims adjudication as well as sending out required COBRA notifications.
Requests and verifies the issuance and accuracy of member ID cards.
Keeping track of supplies and ordering when necessary.
Process Return Mail.
Adhere to and enforces group contract, State and Federal guidelines regarding eligibility standards and requirements.
Be a supportive and collaborative teammate.
Performs other duties and projects as assigned.

 
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.]]></description>
      <pubDate>Tue, 21 Apr 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Medicaid Provider Relations Rep II - Portland, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27775587&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>c16bcd4a-78e1-42a0-b713-4817fe31492a</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Position Summary
This position provides concierge customer service to providers by being the liaison between the Medicaid plans. The Provider Relations Representative is responsible for presenting, promoting, and resolving concerns and issues brought forward by providers and internal staff and develop, improve, and streamline existing provider policies with the goal of removing barriers to providing care. This role will also implement projects and policies that impact providers (includes drafting communications, frequently asked questions, resource guides) to support network needs and promote strong, collaborative relationships. This role will also plan, prepare, and develop training materials for contracted providers and will conduct face-to-face trainings throughout the year. Internally, this role will work closely with our Lead Medicaid Provider Relations Representative for other Medicaid lines of business, multiple departments and is a critical role in supporting daily operations. This is a FT hybrid position based in Portland, Oregon. 

 
Pay Range
$54,668.32 - $68,340.67 salary (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.
https://j.brt.mv/jb.do?reqGK=27775587&refresh=true
 
Benefits:

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


Required Skills, Experience & Education:


Three or more years of provider relations experience.
Requires expertise in industry practices, specialized payment methodologies, Value Based Care agreements, Payer/Provider Strategic Partnerships, and all relevant regulations.
College degree in health care, business, analytics, or related field, or equivalent work experience.
Knowledge of Medicaid claims and benefits.
Proficient in identifying and interpreting Oregon Administrative Rules, CCO and provider contracts
Knowledge of provider payment methodologies including capitation, DRG, CAH and other facility and professional pricing.
Ability to analyze and validate provider claims and payment data.
Experience in manual processing of high dollar checks.
Judgement, self-motivation, and the ability to work independently, and as part of a team.         
Is detail oriented and possess strong analytical, and problem-solving skills. 
Skilled at delivering trainings and facilitating meetings. 
Strong interpersonal communication skills and the ability to develop effective relationship with
network providers, members, and partners.
Proficiency in Microsoft Word, Excel, and PowerPoint.
Ability to work well under pressure with frequent interruptions and shifting priorities.
Must be willing to travel for provider training sessions.
Knowledge of Oregon&rsquo;s Coordinated Care Organization (CCO) Infrastructure.
Must be able to represent the organizations at outside meetings, conferences, and events in a positive
and professional manner. 
Must maintain confidentiality and project a professional business image.

 
Preferred Skills, Experience & Education:


Knowledge of medical office workflows.
Knowledge of other Moda Health products, plans, and networks.


 

Primary Functions:

Assist leadership in negotiating Single Case Agreements; review contract terms to ensure they can be operationalized.
Validation of bi-annual Delivery System Network (DSN) Report in partnership with analytics.
Assists with state, federal and other entity related audits.
Contract configuration, implementation, validation, and assessment.
Implement and coordinate new Medicaid provider focused initiatives.
Identify root causes of claim problems and trends and participate in developing solutions. This includes performing research through available systems, policies, and departments, ensuring timely resolution is achieved.
Work in a consultative role with various departments creating effective processes and updates.
Review and update Medicaid provider manuals, policies and procedures as well as desk manuals.
Oversight and management of Medicaid provider webpage content.
Utilize best practice policies and procedures, work guides or tools to provide improved department process workflows. 
Coordinate and participate in targeted provider meetings, including annual Provider Workshops.
Educate providers on Oregon Administrative Rules and contract language ensuring consistent interpretation.
Provide timely responses to all provider inquiries, within two to three business days.
Provides ongoing support to the Medicaid Operations team. 
Process provider enrollment applications and meet timelines established by management.
Complete and validate Medicaid encounter data.
Conduct on-site provider visits to create strategic provider partnerships to improve health efficiencies, and foster provider experience. 
Attend State and other Medicaid related meetings to learn about new policy and initiative changes that have an impact on operations.
Perform other duties and special projects assigned. 

 
Working Conditions & Contact with Others

Position is hybrid, based in Portland Oregon. Extensive close PC and keyboard work.  Occasional require travel to off-site meetings which may include overnight stays.
Internally with multiple departments.  Externally with providers, providers staff, office administrators, external partners, Oregon Health Authority staff.



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.]]></description>
      <pubDate>Thu, 16 Apr 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Dental Claims Processor I - MILWAUKIE, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27775231&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>4617587e-d816-4598-a44c-19b30b8a8e51</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Position Summary
Review claims to determine the reason the claim did not auto-adjudicate. Make corrections as necessary and process claims according to processing policies and contract provisions. This is a hybrid position based in Milwaukie Oregon. 


Pay Range
$17.34- $18.36 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.
https://j.brt.mv/jb.do?reqGK=27775231&refresh=true



Benefits:

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


Required Skills, Experience & Education:

High school diploma or equivalent.
10-key proficiency of 105 kspm net on a computer numeric keypad.
Type a minimum of 35 wpm net on a computer keyboard.
Ability to achieve and maintain quality and quantity standards.
Possess legible handwriting.
Knowledge of dental terminology, and ADA codes, preferred.
Data Entry experience dealing with all types of plans/claims preferred.
Good reading, verbal, and written communication skills. Ability to listen and communicate clearly and interact professionally, patiently, and courteously with co-workers and supervisor.
Analytical, problem solving, and decision-making skills. Detail oriented and good memory retention with ability to shift priorities.
Good organizational skills, ability to work well under pressure and ability to handle a variety of functions to meet timelines.
Ability to interpret contracts and apply MODA Policies and Procedures to claims processing.
Ability to come into work on time and on a daily basis.
Ability to maintain confidentiality and project a professional business image.


Primary Functions:

Use contract notes and a processing manual to apply correct group specific and standard contract benefits to process pended claims. Know benefits provided by specific plans, how to determine eligibility, how to determine if claims qualify for benefits, how system should pay and how to enter information so correct benefits are paid.
Document in a clear and concise manner and analyze and interpret existing file notes and documentation.
Send clinical request and missing information letters.
Ability to perform some manual calculation of benefits.
Analyze pended claims to determine why the claim pended from auto-adjudication.
Other duties as assigned


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 Imaging Services, Claim Support, and Professional Relations.  
 

 
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.]]></description>
      <pubDate>Thu, 09 Apr 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Sales Executive - Idaho​ - Portland, OR]]></title>
      <link>https://j.brt.mv/jb.do?reqGK=27773269&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>4828d7d5-8442-4bfa-9a50-09457ab96b45</guid>
      <description><![CDATA[Let&rsquo;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&rsquo;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&rsquo;s be better together.

Position Summary
Responsible for selling new business and renewing existing accounts in all employer group size segments and lines of business at appropriate rates to support the financial performance and membership growth of Moda Health and its affiliates in the Idaho market. The Sales Executive will work with senior management to position Moda as the leading insurance carrier in the marketplace.   This is a FT WFH position.

Pay Range
$65,682.16 - $82,107.97 annually (depending on experience). This position is eligible for an incentive. 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.
https://j.brt.mv/jb.do?reqGK=27773269&refresh=true 


Benefits:

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


Required Skills, Experience & Education:

Bachelor&rsquo;s degree in a related field, or an equivalent combination of education and at least 5 years of relevant experience in health insurance or sales. 
Active Idaho health insurance license. 
Ability to work independently with minimal supervision and maintain reliable, on time attendance. 
Valid driver&rsquo;s license, acceptable driving record, and eligibility for coverage under the corporate auto policy. 
Demonstrated consultative selling skills, including presenting, negotiating, and closing new group business. 
Knowledge of medical and dental insurance,  including self-funding, alternative funding, and related contracts and benefit materials. 
Understanding of core insurance operations, including claims, billing, customer service, and related workflows. 
Strong interpersonal communication skills and ability to work effectively with a variety of individuals and groups, representing Moda professionally in the communities served. 
Proficiency with Microsoft Office and ability to learn internal systems and reporting tools. 
Ability to travel within assigned territory and to sales meetings as required.  
Ability to use a pushcart and lift up to 40 lbs. in and out of a car trunk. 

 
Primary Functions:

Drive new medical and dental group sales in the assigned segment, including lead generation, prospecting, and closing. 
Maintain strong relationships with assigned producers, groups, and community partners through regular virtual and field meetings and ongoing consultative support. 
Build and execute acquisition plans for high value prospects, including account strategy and proposal development. 
Deliver presentations and enrollment meetings for groups of varying size and respond to questions accurately and professionally. 
Advise on plan design and funding strategy, aligning solutions to business needs and underwriting guidelines. 
Coordinate with internal partners, including Underwriting and Implementation, to ensure accurate information flow and a smooth handoff after close. 
Monitor competitor offerings and market trends and adjust sales approach accordingly. 
Maintain required activity and pipeline reporting. Build sales skills and product knowledge through training and feedback. 
Identify process and tool improvements and escalate or partner to resolve compliance risks. 
Perform other duties as assigned. 


Working Conditions & Contact with Others

Internally within Sales, Membership Accounting, Underwriting, Business Implementation Unit, Document Services, Marketing, and other departments as needed.  Externally with producers, members, vendors, and various customer contacts. 
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. Occasional travel. 
 

 
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 and Danielle Baker via our humanresources@modahealth.com email.]]></description>
      <pubDate>Tue, 10 Mar 2026 00:00:00 EDT</pubDate>
    </item>
  </channel>
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