Contract Specialist I - Remote

Let’s do great things, together
Founded in Oregon in 1955, ODS, now Moda, is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together.
This position is a subject matter expert regarding health plan contracts; preparation of a high volume of medical and dental plan documents for standard and non-standard groups in compliance with company specifications, turnaround time requirements and all state and federal laws and regulations; production of Summary of Benefit and Coverage and Plan Change Form documents.
​​​This is a Remote Role.

Follow the link below and complete an application for this position.
https://j.brt.mv/jb.do?reqGK=27719378&refresh=true
Benefits:

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

Requirements:

• Bachelor’s degree or combination of college level coursework and relevant experience.
• 1-2 years of insurance experience preferred in areas such as Claims and/or Customer Service.
• Demonstrated proficiency using Adobe and Microsoft Office applications, including Word and Excel.
• Proficiency in computer keyboard; minimum typing ability of 35 wpm.
• Effective verbal, written and interpersonal communications skills.
• Demonstrated ability to identify problems and initiate a solution.
• Ability to initiate and follow departmental policies and procedures.
• Ability to work under pressure and exhibit flexibility in changing priorities.
• Ability to learn new information and apply it to a variety of situations.
• Highly effective organizational skills with the ability to prioritize and meet deadlines.
• Maintain confidentiality and project a professional business image to internal and external customers.
• Ability to come to work on time and on a daily basis.​​​​​​

​​​​​​Contact with Others:
Internally with Sales and Account Services, Regulatory, Claims, Business Implementation Unit, Benefit Configuration, Membership Accounting, Pharmacy, Underwriting, and Contract Services
Duties & Responsibilities:

• Analyze and comprehend source documents such as Group Application identify potential errors, research as appropriate and correct any incorrect information.
• Accurately prepare plan documents for new and renewing standard and non-standard groups.
• Learn and understand company products, including annual changes and new products, and how they relate to plan documents.
• Learn and understand the difference in standard and non-standard language.
• Function as subject matter expert and respond to inquiries from internal departments regarding plan documents.
• Identify discrepancies between source documents and contract department records and articulate questions to relevant internal departments.
• Communicate with internal departments on requested changes to plan documents
• Develop a chronology of actions taken and maintain group files and work logs accordingly.
• Assist in development of policies and procedures.
• Produce Summary of Benefit and Coverage (SBC) and Plan Change Form documents.
• Perform peer-audits and self-audits of plan documents for accuracy.
• Produce a quality product under short turnaround time requirements, in accordance with department productivity and accuracy standards.
• Support peers in a team structure.
• Train lower level staff, such as temporary staff.
• Perform other duties as assigned.

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 37.5 hours per week during peak business periods.

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.
For more information regarding accommodations please direct your questions to Kristy Nehler and Daniel McGinnis via our hradmin@modahealth.com email.