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    <title>Moda Health Jobs</title>
    <link>https://ejob.bz/CompanyPortal.do?companyGK=14095&amp;portalGK=418</link>
    <description><![CDATA[Job Postings available for application.]]></description>
    <language>en-us</language>
    <pubDate>Sun, 07 Jun 2026 13:28:17 EDT</pubDate>
    <lastBuildDate>Sun, 07 Jun 2026 13:28:17 EDT</lastBuildDate>
    <generator>BrightMove ATS</generator>
    <item>
      <title><![CDATA[Medical Claims Processor I - Milwaukie, OR]]></title>
      <link>https://ejob.bz/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://ejob.bz/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[Account Manager Small Group Business - Portland, OR]]></title>
      <link>https://ejob.bz/jb.do?reqGK=27775582&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>565ffe2a-d9cc-4d3b-93f8-a41ba4868048</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:
Responsible for the on-going service and retention of medical and dental accounts assigned.  Primary focus is 1-50 group market.  This includes personal service calls to agents and accounts, responding to both written and verbal inquiries from agents and/or accounts, and includes attending requested meetings by the agents or groups. Objective is to support the financial and membership growth of Moda and its affiliates.
This is a full-time hybrid position based in Portland, Oregon.
Pay Range
$48,900.76 - $61,125.95 (annually) depending on experience. This position is eligible for 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=27775582&refresh=true


Benefits:

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


Primary Functions:

Provide existing accounts with frequent service to assure their retention and to protect them from competition.
Accountable as the principle contact for dealing with escalated questions or problems related to membership accounting, underwriting, and/or claims in cases where the account is not satisfied with the resolution of a problem within Moda Health and its affiliates.
Develop and maintain strong relationships with internal partners to manager customer service experience. 
Establish and maintain strong and appropriate relationships with group administrators and brokers to maintain persistency.  
Perform field audits to assess the degree of account compliance with our established underwriting regulations to ensure that these requirements are being followed.  
Manage assigned medical and dental accounts, responsible for ensuring administrative staff executes tasks as requested, within timeframes, including internal communication and paperwork.
Represent Moda Health at benefit and wellness fairs and conduct open enrollment presentations of the employee benefit package upon request.
Trains and consults with brokers and employers on enrollment, benefits, and electronic service processes.
Influences, demonstrates, and trains employer groups about Moda Health&rsquo;s online electronic services, tools and technologies.
Establish and build a knowledge base relative to trends and development in the medical and dental insurance field, new or revised benefit designs, and related service offerings.  
Accountable for performing delinquent account functions and follow up.
Perform other related duties as assigned by management team.

 
Required Skills & Experience:

2-4 years in health insurance and employee benefits/administration field and/or sales and account management experience.
Demonstrated proficiency in desktop application software including email, word processing, ability to spreadsheet rates and options and creation of presentations, Salesforce and Microsoft Office Suite preferred.
Bilingual preferred.
Ability to communicate effectively both verbally and in writing.
Highly organized, ability to prioritize and manage a large work volume to meet established deadlines.
Ability to navigate a complex organization to accomplish customer satisfaction.
Displays an enthusiastic, fully committed, and self-directed approach to work.
Strong team player.
Ability to engage in community/networking opportunities outside of normal business hours.
Knowledge of medical and dental insurance business as it relates to the processing of claims, handling of premium bills, customer service, and related information.
Presents a positive and professional image in the communities we serve.
Maintain a valid driver&rsquo;s license and a good driving record.  Must be able to provide own reliable transportation.
Maintain a current Oregon Health Insurance license.
Ability to handle a pushcart/hand truck and ability to lift boxes up to 40 lbs in and out of a car trunk.

 
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. Travel as needed.
Works with multiple internal departments and externally with agents, group administrators, and customers.


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[Supervisor, Medical Claims - Milwaukie, OR]]></title>
      <link>https://ejob.bz/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>Wed, 03 Jun 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Medical Claims COB Processor I - Milwaukie, OR]]></title>
      <link>https://ejob.bz/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>Wed, 03 Jun 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Trainer CS & Claims I - Internal Applicants Only - Milwaukie, OR]]></title>
      <link>https://ejob.bz/jb.do?reqGK=27778923&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>806c395b-f05b-45d9-8346-b22fbc42c848</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 providing technical training and guidance to new and current employees. Functional areas of training may include claims processing, customer service, systems navigation, or special projects. Core responsibilities include developing and updating all training materials, facilitating virtual training classes, documenting learner performance, and consistently demonstrating professionalism both in and out of the classroom. This position may also assist other Moda teams as assigned and available.
This is a FT Hybrid role based in Milwaukie, Oregon.
  
Pay Range
$25.58 - $28.78 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=27778923&refresh=true


Benefits:

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

Primary Functions:

Perform training needs assessment on an ongoing basis, to support regularly changing business needs.
Develop and update training materials, to support the training of employees at all levels within the company.
Remain current with policies and procedures of relevant products to be trained and work with leadership to update those policies and procedures as needed.
Accommodate the various learning needs presented in each learning environment, demonstrating respect for each participant.
Conduct training evaluations and remain open to constructive feedback from all stakeholders.
Monitor and evaluate the performance of learners through observation and auditing of work.
Advise department leadership of any performance issues in the learning environment and work collaboratively with leadership to address these issues appropriately.
Participate in or manage projects as assigned.
Maintain personal responsibility for quality and continuous improvement within the job scope.
Adhere to and support the company's mission and culture of caring for others and striving to be better.
Foster an atmosphere of cooperation among peers, learning participants, and leadership.
Perform other duties as assigned.


Required Skills, Experience & Education:

Bachelor's degree in Education, Healthcare, or another relevant field. One (1) year of directly related experience may be substituted.
Demonstrated success in a relevant position (i.e.: claims processor, customer service representative, corporate training), or equivalent education in combination with indirect experience.

Experience in using Facets and other Moda software preferred.


Demonstrated knowledge of adult learning theories and methodologies.
Ability to manage a learning environment supportive of individuals of diverse skill levels, abilities, and experience. The learning environment will primarily be virtual or web based.
Excellent reading, oral, and written communication skills, and ability to interact courteously, professionally, and patiently with all persons internally and externally.
Strong interpersonal and diplomacy skills; adept in conflict resolution, group dynamics, and team building.
Ability to analyze new information quickly and determine an effective and appropriate course of action.
Excellent presentation skills in a variety of settings.
Knowledge in using Microsoft Word, Excel, Power Point, and OneNote.
Ability to maintain confidentiality and project a professional business presence and appearance.
Ability to work well under pressure in a complex and rapidly changing environment.
Ability to learn and follow Moda administrative policies.
Maintain attendance and timeliness in compliance of company standards.



Working Conditions & Contact with Others:

This position collaborates regularly within Claims & CS Training Department, coordinating work with other Moda Departments, Leadership and Stakeholders (IE: Claims Processing, Customer Service, IT, Facilities, Etc.) Directly communicates with Members, Providers, Vendors, and other Insurance Carriers regarding Moda Policies and Member Benefits information.
Work is performed seated or standing for prolonged periods. Close PC monitor and keyboard work. Constant interaction with others on the phone and in person. Work more than 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.
 
#INTONLY]]></description>
      <pubDate>Wed, 03 Jun 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Medical Claims Clerk I - Milwaukie, OR]]></title>
      <link>https://ejob.bz/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
$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=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[Inpatient Claims Processor I - Milwaukie, OR]]></title>
      <link>https://ejob.bz/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[Provider Correspond Coord I - Milwaukie, OR]]></title>
      <link>https://ejob.bz/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://ejob.bz/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[Quality Assurance Auditor - Milwaukie, OR]]></title>
      <link>https://ejob.bz/jb.do?reqGK=27778685&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>9fbf457c-07be-4355-b002-33192500b910</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 Government Programs Quality Assurance Auditor monitors and maintains compliance with state and federal regulations. This role conducts pre-closure audits for Medicare and Medicaid appeals and grievances, tracks department performance, and ensures procedures are followed, appeals are effectuated appropriately, and reporting is accurate. This position also supports staff training and continuous process improvement. 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=27778685&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+ years of experience as Appeal Coordinator or related experience. 

Advanced knowledge of benefit plans and Moda Health administrative policies, products, and business lines, including CMS Medicare and Medicaid rules. 

Strong reading, verbal, written, and interpersonal communication skills. 

Demonstrated analytical, problem-solving, and organizational skills. 

10 key proficiency of 105 kspm net on a computer numeric keypad. 

Type a minimum of 25 wpm net on a computer keyboard. 

Ability to work well under pressure and meet deadlines. 

Proficiency with Microsoft applications such as Word, Excel, or other core operating systems. 

Advanced knowledge of complaint and appeal procedures. 

Strong attention to detail, with a strong focus on quality.

Ability to maintain confidentiality and project a professional business image. 

Ability to meet attendance policies and work schedule, including occasional overtime, weekend, and holiday coverage. 

Aptitude for communicating positively, patiently, and courteously. 

Ability to maintain large workload and meet short turnaround times.


Primary Functions:

Complete pre-closure audits of appeal and grievance cases to ensure accuracy and completeness.
Communicate with staff and other departments to ensure complete and fair reviews of grievances, complaints, and appeals. 
Provide clear, actionable feedback to Appeal Coordinators to improve quality and development.
Monitor data entry for appeals and grievances and perform quality checks on reporting.
Track and trend audit results and provide recommendations to improve quality and efficiency.

Partner with leadership to create and implement initiatives that improve compliance and performance.

Review contracts and supporting documentation to determine appropriate actions. 

Support staff in meeting accuracy and quality standards for case completion. 

Participate in meetings regarding reporting requirements and regulatory changes.

Maintain and update audit tools to align with documentation and reporting requirements. 

Assist with standard verbiage for routine grievances and complaints.

Ensure compliance with state, federal, and plan partner guidelines for member appeal utilization management standards, quality assurance, and quality improvement standards.

Serve as a subject matter expert on Medicare and Medicaid appeals and grievances.

Handle and interpret complex appeals and grievances.

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 Medicare Programs, Medicaid Services, Professional Relations and Contracting, Customer Service, Membership Accounting, Claims, Legal Services, Regulatory, Compliance, Privacy and Healthcare Services teams. Externally with Members, Provider Offices, Independent Review Entities, Attorneys, Coordinated Care Organizations, the Oregon Health Authority 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 & Danielle Baker via our humanresources@modahealth.com email.]]></description>
      <pubDate>Mon, 01 Jun 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Membership Accounting Trainer - Portland, OR]]></title>
      <link>https://ejob.bz/jb.do?reqGK=27778495&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>d6f4fdd4-6786-4cf3-ac95-754e4c774802</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 training, develops, and maintains documentation for Membership Accounting.  Retrains established Membership Accounting specialists when needed and provides ongoing training to Membership Accounting specialists on new procedures and regulations. This is a full-time WFH position. 

Pay Range
$23.34  -  $26.26 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=27778495&refresh=true

 
Benefits

Medical, Dental, Pharmacy, Life & Disability
401K - Matching
FSA
Employee Assistance Program
PTO and paid holidays


Required Skills, Experience, & Education:

High School diploma or equivalent required.
1-2 years training experience in a health insurance environment, preferably in a Membership Accounting role (billing, eligibility & reconciliation) department preferred. 
Ability to instruct, motivate, and direct individuals at various skill levels, face to face and in the classroom environment.
Demonstrate strong, effective, and diplomatic interpersonal skills with employees of all levels and participate effectively as a team player. 
Demonstrate analytic skills in identifying technical needs and implementing an effective course of action.
Demonstrate training skills both in a small group and large group setting with excellent presentation skills.
Knowledge of Word, Excel, and ability to navigate web-based programs.
Excellent reading, verbal, and written communication skills, and the ability to interact professionally, patiently, and courteously with others. 
Good analytical, problem solving, decision making, and organizational, and detail-oriented skills with ability to shift priorities.
Good organizational ability to work under pressure, to handle a variety of functions and meet deadlines. 
Ability to come to work on time on a daily basis.  Maintain attendance above company standards.
Maintain confidentiality and project a professional presence and appearance. 
Ability to read and interpret policy contracts and incorporate language in to UPM&rsquo;s.
Ability to understand State and Federal legislation affecting eligibility and billing administration (CMS, FFM, CCO/DCO, etc.) over multiple states.
Ability to take a concept and independently develop and create a training plan, workflows, and procedures that can be understood by trainees of all skill and experience levels.


Primary Functions:

Responsible for department product (Medicare, Medicaid, Individual, Group and BHS) training for new hires, ongoing refresher training an annual training.  
Develops courses and modules for use in the training of all levels of Membership Accounting Specialists.  This includes the development and updating of course content and training materials.  Coordinates to ensure consistency throughout the company. 
Monitor performance expectations and results for new hires, provide coaching when necessary and facilitate weekly 1:1 meetings.
Develops and implements presentations in a clear, user friendly manner and accommodates various adult learning styles.
Conducts end of course evaluations and action planning.
Creates and updates documentation, department procedures and resource materials as needed and/or necessary.
Advises the Supervisor of any personnel issues, utilizing proper judgement in assessing any necessary action to be taken.
Assists in the planning, organizing, and directing the activities and workflow of the department.
Participates in or manages projects as assigned.
Fosters and atmosphere of team spirit and portrays an outgoing and positive attitude with peers, Moda and BHS Leadership, Customers and/or trainees at all times.
Collaborates with other departments to identify training needs, coordinates and implements classes when appropriate. 
Responsible for ensuring department specific HPMS, CCO, FFM, or any State and/or Federal information is reviewed, discussed, documented, implemented, audited, and trained based on the guidance. 
Responsible for ensuring all Medicare, Medicaid, FFM, BHS, Group, etc. related Policies and Procedures are accurate, up to date, and reviewed, at minimum, annually. 
Interpret contracts, new regulations, CMS memo&rsquo;s, COBRA rules, etc. and determine actions required.  Recommend procedures for department, write UPM&rsquo;s.

 
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, 28 May 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Membership Acct Qual Analyst - Portland, OR]]></title>
      <link>https://ejob.bz/jb.do?reqGK=27778496&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>acb800a0-e41e-422d-9f63-dec72a0ca59d</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 accurate quality assurance auditing of pre and post enrollment, billing and reconciliation functions as performed by Membership Accounting specialists of all levels.  Track and report on quality trending as it relates to specific specialists as well as department level production. This is a full-time WFH role.

Pay Range
$23.34 - $26.26hourly, 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=27778496&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.
1-2 years quality review experience in a health insurance environment, preferably in a Membership Accounting (enrollment, billing & reconciliation) department preferred.
Demonstrate strong, effective, and diplomatic interpersonal skills with employees of all levels and participate effectively as a team player. 
Knowledge of Word, Excel, and ability to navigate web-based programs.
Excellent reading, verbal, and written communication skills, and the ability to interact professionally, patiently, and courteously with others. 
Good analytical, problem solving, decision making and organizational, and detail-oriented skills with ability to shift priorities. 
Ability to come in to work on time and on a daily basis.  Maintain attendance above company standards.
Maintain confidentiality and project a professional business presence and appearance. 


Primary Functions:

Audit enrollments, billings and reconciliation daily using statistically valid sampling methodology, using prescribed audit criteria.  Performs simple adjustments as necessary. 
Ensures departmental quality assurance standards, employer group Statement of Work, and State and Federal Regulations are adhered to through auditing all Membership Accounting Specialist duties. 
Conduct in-depth enrollment, billing, and reconciliation on performance groups, as well as focused audits for specifically identified situations or specialists on a scheduled basis.  
Prepares required monthly and/or quarterly reports for specific group performance guarantees, production, and accuracy results. 
Identify trends from audit results and recommend improvements to increase overall quality. 
Creates and updates documentation, department procedures, and resource materials as needed.
Responsible for quality and continuous improvement within job scope. 
Contributes to and supports the company&rsquo;s quality initiatives by encouraging team and individual contributions toward the company&rsquo;s quality improvement efforts. 
Fosters and atmosphere of team spirit and portrays an outgoing and positive attitude with peers, Moda and BHS Leadership, Customers, trainees, and Specialists. 
Responsible for regularly scheduled operational audits of staff members for your respective team and product line. 
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 Membership Accounting Leadership Team, Sales and Account Services, Customer Service, Business Implementation Unit (BIU), Accounting, IS, and Medicare Operations. Externally with Clients and Customers.



 
 
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, 28 May 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Sales Assistant I - Portland, OR]]></title>
      <link>https://ejob.bz/jb.do?reqGK=27778493&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>352637fa-dbcb-4193-9c46-6642fefde699</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 full-time hybrid position based in Portland, Oregon.


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=27778493&refresh=true



Benefits:

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


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 and Danielle Baker via our humanresources@modahealth.com email.]]></description>
      <pubDate>Thu, 28 May 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Medicaid Financial Accountant II - Portland, OR]]></title>
      <link>https://ejob.bz/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
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. This is a hybrid position based in Portland, Oregon.

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>Wed, 27 May 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Medical Reimburse Analyst I, II, or III (DOE) - Portland, OR]]></title>
      <link>https://ejob.bz/jb.do?reqGK=27778398&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>889776a3-2f8b-46f6-963e-2dd36b1357bc</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 Reimbursement Configuration Analysts works with our most complex pricing configuration.  Evaluates, designs, tests and performs configuration needed to meet the business requirements for contracts of the highest complexity, with a substantial variety of pricing methodologies including CMS, DRG, APC, Medicaid, RBRVS etc.  Assures end results achieve the highest levels of accuracy and claims auto adjudication. This is a FT WFH role. 

Pay Range
$49,878.77 - $82,107.97 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=27778398&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 or healthcare related field, or equivalent work experience
Minimum 3-5 years&rsquo; experience in the health insurance industry, with a strong medical claims background preferred
Minimum 3-5 years&rsquo; experience in pricing configuration, preferably in Facets and NetworX
Proficient in interpretation and analysis of provider contracts
Proven ability to translate complex provider contracts into pricing configuration
Skilled at configuration lifecycle of analysis, design, configuration, testing and implementation
Proven problem solving and troubleshooting skills, employing &ldquo;outside the box&rdquo; thinking
Expert MS Excel skills are required
Demonstrated knowledge of pricing methodologies, including but not limited to Medicare and Medicaid, DRG, SNF, RBRVS, APC etc.
Ability to clearly document processes
Ability to teach configuration skill sets to other staff
Certified Professional Coder designation and experience is a plus
PC proficiency with Microsoft office applications and Outlook
Ability to work well under pressure with frequent interruptions and shifting priorities
Ability to maintain confidentiality, and project a positive and professional business image
Ability to come to work on time daily
Ability to work independently, with minimal supervision

 
Primary Functions:

Analyzes provider contracts for institutional and non-institutional providers, developing business requirements.
Analyzes pricing business requirements, develops and evaluates alternatives, prepares proposals and design specifications for complex configuration systems or applications to meet the identified needs, goals and metrics.
Configures and tests results, assuring that the highest levels of quality and claims auto adjudication are met.
Consults with Provider Contracting and/or Analytics to determine appropriate interpretation of contract intent.
Works with varying and complex pricing methodologies including, but not limited to, Medicare and Medicaid methodologies, Medicaid, DRG, APC, Outliers, RBRVS, Fee Schedules etc.
Designs and creates qualifiers within the system to assure appropriate services are priced at the correct rates.
Evaluates provider set up and works with Provider Data Maintenance team to assure that pricing and provider data are in synch.
Researches and resolves critical issues that are referred from Claims, Customer Service, Provider Relations, Credentialing, Analytics and Appeals.
Represents the unit on corporate and cross functional projects as assigned.
Documents processes according to Moda and unit standards.
Provides training to other staff as assigned.
Mentors other staff as assigned.
Attends software vendor subcommittee meetings to further knowledge and keep aligned with system changes and solutions.
Other duties as assigned 

 
Working Conditions:

Works with others at all levels throughout the organization including Provider Contracting, Claims, Customer Service, Benefit Configuration, IT, Data Analytics and others with frequently confidential information. Works with outside vendors and staff at other health plans as needed to identify and vet ideas.
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>Wed, 27 May 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Associate Account Coordinator - Portland, OR]]></title>
      <link>https://ejob.bz/jb.do?reqGK=27778311&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>3a07d5d0-4b86-4b3a-87cd-5ee9c6062e81</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
Support assigned key accounts to strengthen relationships and ensure retention. This role partners with internal team members and clients to deliver internal and external support, including ongoing service meetings with clients and their brokers or consultants. This is a 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=27778311&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 experience in health insurance, marketing, sales, underwriting, or a related field.
2 years of health insurance experience including funding, terminology, billing, customer service, and benefit operations.
Strong customer service skills with the ability to clearly articulate and resolve issues.
Demonstrated organizational skills with the ability to prioritize and meet deadlines.
Ability to communicate client and member needs to internal partners to improve workflows.
Strong presentation skills.
Strong analytical, problem solving, and organizational skills with attention to detail.
Ability to work effectively with a wide range of individuals to support account retention.
Strong verbal and written communication skills.
Ability to work independently with minimal supervision.
Ability to manage multiple priorities in a fast-paced environment.
Maintains a professional and positive representation in the community.
Demonstrated relationship building skills and ability to work collaboratively.
Proficiency with Microsoft Office including Teams, Word, Excel, and PowerPoint.
Valid driver&rsquo;s license with a good driving record.
Obtain a Oregon Health Insurance license preferred.
Ability to handle a pushcart/hand truck and is able to lift boxes up to 40 pounds in and out of a car trunk.

 
Primary Functions:

Partner with the Account Executive to analyze and identify root causes of complex service issues for clients and their brokers or consultants. Direct functional experts such as membership accounting, customer service, pharmacy operations, and IT on corrective action steps to ensure full resolution.
Support the review and analysis of contract provisions, assist with renewal proposal coordination, and coordinate open enrollment activities including presentations, meetings, and benefit reviews.
Support the team in establishing and executing quarterly and annual service goals.
Represent Moda and Delta Dental at benefit and wellness events.
Participate in account strategy discussions.
Demonstrate knowledge of each client&rsquo;s benefits and contract to support service delivery credibility.
Prepare, review, and respond to client and broker inquiries. Partner with internal departments and vendors to research and resolve service issues.
Review and manage client reporting and performance guarantees on a monthly, quarterly, and annual basis. Ensure timely delivery in accordance with contractual requirements.
Assist with responses to Requests for Proposal for both new and existing business. Review responses, ensure quality, and manage deadlines.
Support development and coordination of finalist presentations as needed.
Complete accurate internal documentation for changes, renewals, and terminations to ensure external timelines are met.
Partner with the Account Executive to develop customized client materials including open enrollment materials, member guides, and other communications.
Deliver enrollment presentations and represent Moda at benefit and wellness events as assigned.
Coordinate with external vendors and subcontractors as appropriate.
Attend meetings, record accurate minutes, organize notes into a structured format, and distribute follow up items in a timely manner.
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. Occasional travel.

Internally with multiple departments. Externally with clients and their consultants, agents, or 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>Tue, 26 May 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Clinical Care Advance Configuration Analyst III - Portland, OR]]></title>
      <link>https://ejob.bz/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>Thu, 21 May 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Care Management Coordinator I - Milwaukie, OR]]></title>
      <link>https://ejob.bz/jb.do?reqGK=27778122&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>e6c194c7-e331-4f5a-b815-1a6be7b0bbe6</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:
The Care Management Coordinator is an outreach specialist who provides administrative, logistical, and communication support to the Moda Case Management Team.  They do this by assisting with member engagement through outreach campaigns, collecting member-specific health data, documenting outreach and engagement, and performing data entry. 
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=27778122&refresh=true


Benefits:

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


Primary Functions:


Conduct outreach and mailing campaigns to encourage member engagement in case management. 
Gather social, clinical, and functional information to identify member needs and support case management planning. 
Complete Health Risk Assessments and contribute accurate communication and documentation within the member&rsquo;s health record. 
Serve as a liaison between members and the healthcare team, collaborating with RN and LCSW Case Managers to communicate needs, initiate referrals, and coordinate resources. 
Coordinate and facilitate referrals to appropriate programs and community services, including resource navigation such as food banks, senior services, transportation, and equipment needs. 
Arrange logistics such as transportation, follow-up appointments, and ensuring necessary resources or equipment are available. 
Provide administrative support, including documentation, paperwork, and helping members navigate the healthcare system. 
Support workflow efficiency by handling non-clinical, time-consuming tasks that assist but do not replace licensed case managers. 
Maintain consistent, accurate, and timely documentation while organizing and prioritizing work to meet performance standards, corporate goals, and timelines. 
Perform other duties and responsibilities as assigned.


 
Required Skills & Experience:

Proficiency with Microsoft Office applications and ability to type a minimum of 35 wpm.
Prefer healthcare experience as a MA, CNA, LPN/LVN, MSW, LPC, or MHT.
Strong analytical, problem-solving, memory retention, organizational, and detail-oriented skills.
Exceptional verbal and interpersonal communication skills.
Ability to work well under pressure.
Ability to project a professional business image, both telephonically and in person.
Strong attendance and reliability.

 
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 is required to support remote work. Must be comfortable being on camera for virtual training and meetings. Work in excess of the standard workweek, including evenings and occasional weekends, to meet business needs.


Internally with various departments. Externally as needed.


 
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, 21 May 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Care Management Coordinator II - Milwaukie, OR]]></title>
      <link>https://ejob.bz/jb.do?reqGK=27778124&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>7177367b-7da4-41ac-a624-0178a8f44437</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:
Provide support to the Healthcare Services Case Management team by assisting in the monitoring and review of all tiers of care coordination. Supports the Moda Clinical Care Team by assisting in member engagement through outreach campaigns, collecting member-specific health data, documenting member outreach/engagement, and data entry. The coordinator utilizes their clinical healthcare experience to navigate member needs and develop care plans directed towards improving member health outcomes. Completes reviews of annual and periodic health risk assessment surveys on members and provides reportable information to the supervisor for yearly reporting as appropriate. 
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=27778124&refresh=true


Benefits:

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


Primary Functions:


Initiates mailing campaigns to encourage case management engagement.
Research social determinants of health and equity needs that affect members and develop processes to enroll these members in case management services. 
Reviews related referral and care plans monthly to meet compliance requirements.
Coordinate and initiate referrals to appropriate services and programs utilizing a large network of resources to assist member needs
Assists with triage of Health-Related Services funds requests 
Collect information about a member&rsquo;s social, clinical, and functional status to identify individual and case management needs. 
Create, enter, and complete Health Risk Assessments and initiate appropriate care plans within the members health record. 
Collaborate with RN Case Managers to initiate referrals, communicate specific member needs, and to assist in care planning. 
Communicate effectively with other Medical Management support staff.
Analyze claims and encounters to identify high utilization members that would benefit from higher care coordination services. 
Effectively uses the Moda Health systems to accurately determine eligibility, benefit plan, and physician networks associated with the member&rsquo;s plan.
Utilizes the Moda Health systems for documentation of contact with providers and members.
Performs outreach calls to inform patients about care coordination services and start case workflows.
Ensure adherence of Health Insurance Portability and Accountability Act (HIPPA) and other regulatory guidelines including privacy and security.
Identifies member needs and research alternative solutions.
Completes other duties and special projects as assigned by the CM Supervisor and/or the HCS Manager.


 
Required Skills & Experience:

2 - 4 years of experience in a medical office and/or case management experience required
Community/Traditional Health worker certification or Bachelor of Social Work (BSW) required 
Proficient in Microsoft Office applications
Type a minimum of 35 wpm
Excellent written, verbal and interpersonal communication skills 
Excellent organizational and detail orientation skills
Must present a professional business image in all settings
Ability to work well under pressure, work with frequent interruptions and shifting priorities
Strong problem-solving skills and critical thinking required
Ability to work independently, as well as part of a team, dealing with all levels of staff, members, providers, in a professional manner
Demonstrates professionalism, empathy, and discretion when working with patients, caregivers, and medical staff; adheres to HIPAA regulations.
High level of understanding of medical terminology, state and federal regulations and social determinates of health and equity
Knowledge of health plan benefits
Familiar with CMS (Medicare/Medicaid) rules and regulations

 
 
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, 21 May 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Manager, Clinical Pharmacy - Portland, OR]]></title>
      <link>https://ejob.bz/jb.do?reqGK=27778160&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>de29aada-351c-4322-a6dd-24a170974634</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 Clinical Pharmacy role oversees and maintains clinical aspects of Commercial, Medicare, and Medicaid pharmacy-related programs. This position focuses on initiating, supporting, and continuing evidence-based, cost-effective medication utilization strategies and clinical programs, while providing clinical support to internal departments and external customers. This role is supported by two Clinical Pharmacy Supervisors, each responsible for distinct workstreams. One supervisor oversees prior authorization and related functions, while the other leads development of drug monographs for the Pharmacy and Therapeutics Committee, including formulary management and policy development. The Manager of Clinical Pharmacy position is responsible for leading all these key areas of work within our health plan. 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
$150,000.00- $200,000.00 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. 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=27778160&refresh=true


Benefits:

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


Required Skills, Experience & Education:

Doctor of Pharmacy degree (Pharm.D.) preferred, or Bachelors of Pharmacy degree.
Valid Registered Pharmacist (RPh) license in the State of Oregon, or ability to become licensed within 60 days of employment.
Success managing a team of pharmacists preferred, or two or more years of supervisory/management experience. 
Three or more years of managed care experience related to Commercial, Medicare, and/or Medicaid benefit administration. Deep Medicare Part D expertise preferred.
Demonstrated ability to lead multiple complex, concurrent projects and initiatives.
Demonstrated ability to work with large data sets and experience in identifying and implementing process improvements. 
Ability to work collaboratively with other departments across the Moda organization.
Advanced understanding of managed care pharmacy landscape and the medication use system.
Demonstrate a commitment to service, organization values, and professionalism through appropriate conduct and demeanor.
Ability to maintain confidentiality and project a professional business image.
Regular attendance, dependability, and promptness required. Ability to attend regular meetings in-person and as needed.
Proficient with Microsoft Office applications.
Post-graduate training (residency and/or fellowship) preferred, although not required.

 
Primary Functions:

Oversight of core clinical pharmacy functions, including, but not limited to formulary management (including Pharmacy & Therapeutics Committee), utilization management, prior authorization, and other clinical pharmacy programs.
Provide oversight and ensure compliance with pharmacy law, state and federal regulations, pharmacy business practices, accreditation practices, and other internal organization policies.
Manages accessibility, quality, and cost-effectiveness of medication therapy for members and providers.
Represent clinical pharmacy in audits, appeals-related hearings, and other formal regulatory review processes.  
Develop and maintain pharmacy program policies and procedures to ensure compliance with internal and external requirements.
Participate as a clinical leader across the operational units to deliver the highest levels of program performance and integrated clinical service to internal and external clients.
Serve as the clinical leader and point of contact and collaborate with internal and external partners, clients, and vendors to execute pharmacy management strategies and programs.
Represent clinical pharmacy in internal committee meetings and/or cross-functional initiatives ranging from regulatory and compliance to member and provider engagement activities. 
Oversees the assignment and completion of key clinical pharmacy activities, such as new drug evaluations, medical necessity criteria creation and maintenance, and formulary enhancements.
Provide concise, applicable, comprehensive, and timely responses to requests for drug information from members, clients, providers, and internal teams.
Manage escalated issues arising from a multitude of sources, such as members, providers, vendors, clients, and internal teams or departments, such as customer service or appeals and grievances.
In collaboration with other department leaders, oversee the quality of the clinical projects, tasks, and deliverables through productivity reporting and quality assurance processes. 
Review, analyze, evaluate, and interpret scientific and medical journals, financial reports, and legal documents to provide recommendations or guidance to other stakeholders.
Lead and complete significant projects as assigned to meet team and/or business objectives.
Provide leadership, coaching, performance management, and professional development for clinical pharmacy staff and supervisors. 
Provide oversight and leadership to quality and population health clinical programs.
Support Director, Clinical Pharmacy and other department leaders on special projects and initiatives that support the current and future needs of the organization and teams.
Performs 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 40 hours per week, including evenings and occasional weekends, to meet business needs.

Interdepartmental work within the company including Actuary & Analytics, Customer Service, Healthcare Services, Legal, Marketing, Medicare/Medicaid, Membership Accounting, Quality Management, Policy, Regulatory & Compliance, Sales & Account Services, and Underwriting. External work outside of the company with Pharmacy Benefit Manager (PBM), medical management organizations, CMS, pharmaceutical manufacturers, consultants/producers, auditors, business partners/vendors, clients, prospective clients, physicians and other prescribing 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>Thu, 21 May 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[​​Sr Cloud & Infrastructure Engineer​ - Portland, OR]]></title>
      <link>https://ejob.bz/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[Medicaid Customer Service Representative (***) - Milwaukie, OR]]></title>
      <link>https://ejob.bz/jb.do?reqGK=27774866&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>6385b365-d273-4fe9-960b-bed926cb852b</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:
Are you a problem-solver with excellent communication skills who thrives in a fast-paced, team-driven environment?
We&rsquo;re looking for a Medicaid Customer Service Representative to join our team and deliver exceptional service to members of the Oregon Health Plan (OHP). This is a full-time WFH position with availability required from 7:30 AM&ndash;5:30 PM, Monday through Friday.

 
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=27774866&refresh=true
 
Benefits:

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

 
Required Qualifications

At least 1 year of experience in a medical insurance or healthcare-related field.
Minimum 1 year of call center or customer service experience.
High School Diploma or equivalent.
Strong computer skills, including typing, 10-key, and Microsoft Office proficiency.
Ability to consistently meet Moda&rsquo;s attendance and punctuality standards as part of job performance expectations.
High speed internet (cable or fiber)

 
Preferred Qualifications

Experience with medical health insurance or government healthcare programs.
Knowledge of medical terminology.
Medical billing and coding experience
Experience with trauma informed care model

 
Primary Functions:

Answer a high volume of calls with professionalism, empathy, and a commitment to solving customer concerns.
Provide accurate, timely information about OHP medical and pharmacy benefits.
Research and resolve complex inquiries to ensure customer satisfaction.
Maintain confidentiality and adhere to privacy policies and HIPAA regulations.
Document calls thoroughly and efficiently using the latest software tools.
Collaborate with a supportive team and experienced leadership to ensure the best outcomes.
Continuously adapt to evolving customer needs in a dynamic work environment.

 
Why Join Us?

Comprehensive Training: We&rsquo;ll set you up for success with the tools and knowledge you need.
Professional Growth: Explore opportunities for career advancement within a growing organization.
Collaborative Environment: Be part of a team that values innovation, diversity, and mutual support.

 
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[Prior Authorization Pharmacist - Portland, OR]]></title>
      <link>https://ejob.bz/jb.do?reqGK=27772987&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>03b2ed05-cc0c-498d-b989-facbdf74ff70</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 currently seeking a skilled and dedicated pharmacist to join our clinical pharmacy team. In this role, you will have the exciting opportunity to focus on the vital prior authorization functions of our work. Your primary responsibilities will involve making coverage determinations and completing appeal requests, using your clinical expertise to provide coverage decisions based on established criteria, guidelines, and specific plan design. By joining our team, you will be part of a dynamic environment where you can make a significant impact on patient care and contribute to the overall success of our healthcare organization. This is FT WFH position. 
 
Pay Range
$103,893.01 - $132,461.48 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=27772987&refresh=true 
 

Benefits:

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


Required Skills, Experience & Education:

Current active and unrestricted Oregon Registered Pharmacist license, or eligible for Oregon licensure which is to be obtained within 60 days of hire date
Effective communication and interpersonal skills to interact with healthcare providers, internal teams, and external stakeholders
Commitment to service, organizational values, and professionalism through appropriate conduct and demeanor always
Works well under pressure with frequent interruptions and shifting priorities
Follow the company HR policies, Code of Conduct, and all department policies and procedures including protecting confidential company, employee, and customer information

Preferred Skills

Doctor of Pharmacy degree (Pharm.D.)
Experience in clinical therapeutics for specialty drugs 
Two to three years of managed care experience

Primary Functions:

Evaluate medication requests for coverage (e.g., prior authorization reviews, non-formulary requests, step therapy exceptions), conducting thorough clinical reviews and assessing their compliance with established clinical guidelines, formularies, and policies
Provide prior authorization pharmacist coverage for rotating weekends and holidays
Provide ad hoc or on call support for urgent medication requests and provide internal pharmacist support to the pharmacy team, appeals unit, and customer services department
Perform coverage determination reviews for all lines of business (i.e., commercial, exchange, government) for pharmacy and medical (physician-administered or home infusion) medications
Participate in the appeals and grievances process by providing clinical expertise and reviewing medication-related appeals and complaints
Complete medical literature evaluation using primary, secondary, and tertiary drug resources to support coverage decision-making and recommendations 
Perform peer-to-peer reviews with providers when requested 
Make recommendations on medication edit improvements (e.g., programming) and coverage criteria, based on utilization and findings during coverage determination reviews
Provide clear, comprehensive, and timely responses to requests for drug information to members, clients, providers, and internal staff via detailed and thorough documentation within coverage determinations, appeal documentation, and email inquiries
Organize workload, set priorities, complete assignments in a timely manner and utilize resources appropriately while complying with department program standards
Participate in and support department quality assurance and ongoing improvement practices
Remain current on all communications and updated processes relayed through multiple team communication channels and apply to daily duties and responsibilities
Support staff training and development as required
Review, update, and maintain applicable policies and procedures related to clinical pharmacy services 
Performs all other related duties as assigned by departmental managers


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>Thu, 14 May 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Manager, Pharmacy Business Development - Portland, OR]]></title>
      <link>https://ejob.bz/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://ejob.bz/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://ejob.bz/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[Health Navigator I (***) - Milwaukie, OR]]></title>
      <link>https://ejob.bz/jb.do?reqGK=27777445&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>82acbba5-0e27-46c8-950a-a8ddc2704b26</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
Starting hourly rate is $19.50 
**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=27777445&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>Tue, 12 May 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Data Science Business Systems Analyst - Portland, OR]]></title>
      <link>https://ejob.bz/jb.do?reqGK=27777150&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>9d708686-43e8-4b31-8f10-44877fdf80e8</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 Science BSA gathers and documents business requirements for the Enterprise Data Warehouse (EDW), including processes, system flows, and functional designs for break-fixes, upgrades, vendor implementations, and product enhancements.  This position analyzes existing systems, designs new systems, and evaluates requirements and specifications throughout the software development lifecycle, including testing and implementation for projects with significant departmental or organizational impact. This is a FT WFH position. 

Pay Range
$71,906.46 - $93,480.50 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=27777150&refresh=true


 
Benefits:

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


Required Skills, Experience & Education:

8+ years of experience in technical or business analysis, including at least 5 years as a Business Systems Analyst. Experience with data teams or data warehouses and familiarity with health insurance administration or clinical/operational healthcare are preferred.  
Experience building and/or maintaining data dictionaries with demonstrated procedural and technical writing skills. 
2+ years of experience supporting analytical and reporting use-cases involving large datasets and/or data warehouses. 
Ability to read, write, and execute SQL statements.
Experience with SQL Server and cloud-based data warehouses such as Snowflake, Microsoft Synapse/Fabric, BigQuery, Redshift, or Databricks preferred. 
Expert facilitation skills for both large and small group meetings or working sessions. 
Proven critical thinking, time management, and problem-solving skills. 
Ability to work collaboratively in a production support team and independently with minimal supervision. 
Ability to work well under pressure in a fast-paced environment with frequent interruptions and shifting priorities while managing multiple assignments. 
Strong organizational skills with the ability to plan, prioritize, and meet deadlines. 
Effective verbal and written communication skills with internal and external partners and stakeholders of varying technical skill levels. 

 
Preferred Skills, Experience & Education:

Ability to work with at least one additional language on top of SQL, such as SAS, R, or Python. 
Familiarity with modern data transformation tools such as dbt or Coalesce preferred. 

 
Primary Functions:

Model best practice requirements engineering for all aspects of the development lifecycle activities, including elicitation, analysis, and prioritization of functional and non-functional requirements. 
Mentor and support junior analysts to ensure alignment with enterprise architecture and strategic objectives. 
Partner with business and technical leadership to define, validate, and approve detailed functional specifications and acceptance criteria for high-impact initiatives. 
Proactively identify and source potential Data Science projects based on organizational priorities and EDW capabilities.  
Author and review technical documentation for enterprise-level systems, ensuring compliance with Data Science standards and influencing documentation best practices. 
Lead the development of business cases, contingency plans, business metrics and measurements, process models, training materials, new procedures, test scripts, ad-hoc reports, and smart solutioning for process improvements. 
Participate in the review and approval of system designs, logical data designs, report designs, interface designs, and conversion plans.  Review and approve high-level data flows, functional specifications, and implementation plans. Suggest design alternatives as appropriate. 
Develop, document, and implement test plans, scenarios, and outcomes following Data Science standards to ensure stakeholder requirements are met. 
Perform post-implementation quality assurance and troubleshooting, ensuring adequate documentation following department standards. 
Coordinate and collaborate with IT and Corporate project managers on projects involving the EDW.  
Provide training and communicate system changes to end-users and other impacted staff. 
Perform ongoing production support, scope bug fixes, and ensure that the resolution of complex issues for critical data-related applications is provided by the dev team to minimize business disruption. 
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.

 
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, 07 May 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Data Engineer I, II - Portland, OR]]></title>
      <link>https://ejob.bz/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>Thu, 07 May 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Sr Software Engineer - Portland, OR]]></title>
      <link>https://ejob.bz/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[Software Engineer - Portland, OR]]></title>
      <link>https://ejob.bz/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>Wed, 06 May 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Health Coach (NBC-HWC) - Portland, OR]]></title>
      <link>https://ejob.bz/jb.do?reqGK=27776852&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>d0bdfb30-d202-4f4f-9f64-7150acebf2bc</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. 


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=27776852&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>Mon, 04 May 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[​​Population Health Program Coordinator​ - Portland, OR]]></title>
      <link>https://ejob.bz/jb.do?reqGK=27776759&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>181a4958-cc43-40c8-8e6a-cf59a981648f</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 role supports multiple teams within Population Health by assisting with program management, coordinating client-specific program development, and performing administrative tasks as needed. The coordinator will plan and manage project activities related to key corporate initiatives, support the development of project work plans, execute project tasks and deliverables, help define program requirements, document processes, and report project status. This role also includes administrative responsibilities to ensure departmental goals are met.  This is a FT WFH role.
 
Pay Range
$23.34 - $26.26 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=27776759&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 higher in healthcare or a related field, and/or a licensed professional in a related healthcare field, or equivalent experience, preferably in the healthcare industry.
1-3 years of experience coordinating projects with cross-functional business impact; familiarity with project management tools preferred.
Proficiency in Microsoft Word, Excel, PowerPoint, and Access, with the ability to learn new software applications.
Excellent verbal, written and interpersonal communication skills, including conflict management.
Consistent, on-time attendance, and able to come to work on time and daily.
Maintain a professional presence in all communications.
Strong organizational and time-management skills.
Project coordination experience with the ability to manage multiple projects simultaneously.
Self-motivated and able to work independently with minimal supervision.
Strong problem-solving skills with a logical, systematic approach.
Ability to influence others, build consensus, and gain cooperation.

 
Primary Functions:

Participate in the planning and execution of small-scale projects.
Provide daily project support, including documenting requirements, tracking and managing deliverables, coordinating meetings, and reporting outcomes.
Effectively manage time while tracking and prioritizing a dynamic range of tasks and assignments.
Implement projects and programs assigned to the team, ensuring alignment with department objectives and strategic goals.
Demonstrate strong interpersonal skills in interactions with employees, supervisors, stakeholders, other departments, and vendors to maximize productivity and foster positive working relationships.
Complete assignments on time and regularly communicate project status, prioritization, and completion with department staff.
Maintain audit tools and documentation to ensure compliance and accuracy.
Oversee data accuracy and ensure timely reporting.
Maintain confidentiality and project a professional business image.
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 standard workweek, including evenings and occasional weekends, to meet business need.


Internally with Population Health and Healthcare Services colleagues and leadership. Externally with vendors and employer groups.


 

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, 03 May 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Appeal Coordinator I  - Milwaukie, OR]]></title>
      <link>https://ejob.bz/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://ejob.bz/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://ejob.bz/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[Licensed Behavioral Health Care Coordinator I (LCSW, LPC, LMFT) - Portland, OR]]></title>
      <link>https://ejob.bz/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 - $89,988.57 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>Sun, 19 Apr 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Medical Claims Savings Coordinator I - Milwaukie, OR]]></title>
      <link>https://ejob.bz/jb.do?reqGK=27775724&amp;companyGK=14095&amp;portalGK=418</link>
      <guid>cd72f4f6-4783-4d08-873f-539d625a378c</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
Coordinate Optum TruClaim, ClearHealth Access Network (CAN) and Fee Negotiations for Bill Management services, Zelis Code Edits and Repricing and provides support for Optum, ClearHealth and Zelis vendors. This is a FT WFH role. 


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=27775724&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 education or equivalent.
2 years medical claim processing or customer service dealing with all types of plans/claims consistently exceeding performance levels.
Strong reading, writing and verbal communication skills to communicate positively, effectively, patiently, and courteously with other staff members, vendor, providers, and members.
Excellent analytical, problem solving, decision making and organizational, and detail-oriented skills with ability to shift priorities in a rapidly changing environment.  Must have the ability to work with frequent interruptions and demonstrate professional leadership.
Demonstrate strong, effective, and diplomatic interpersonal skills with employees of all levels and to participate effectively as a team player.
Ability to take initiative and be a self-starter.
Ability to perform project management.
10-key proficiency of 105 spm net on a computer numeric keypad.
Type a minimum of 35 wpm net on a computer keyboard.
Good organizational ability to work under pressure to handle variety of functions and meet timelines.
Maintain confidentiality and project a professional business presence and appearance.
Proficiency in Facets, Benefit Tracker, Content Manager.
Knowledge and understanding of Moda administrative policies.
Knowledge of medical billing and coding and/or the ability to learn & apply these concepts.  Knowledge of principles of clinical editing would be helpful.  Certified Professional Coder (CPC) designation would be helpful.
Proficiency with personal computers, Internet research, and software applications such as Excel, Word, and PowerPoint.


Primary Functions:

Responsible for all aspects of Optum TruClaim, ClearHealth Access Network and Fee Negotiations repricing services including receiving, processing, and reporting data to and from vendors.
Review and apply established TruClaim edits to appropriate claims from the daily TruClaim Report.
Review and apply established repricing amounts to appropriate claims from the daily ClearHealth Network and Fee Negotiations/Bill Management reports.
Generates weekly report of non-utilized TruClaim edits.  
Provides suggestions to Clinical Policy & Reimbursement Analyst for needed customizations and/or ways to optimize use of TruClaim services.
Process Optum, Clear Health, Zelis and Macro Health Vendor Payments and Refunds.
Review and assist with member and provider disputes and appeals.  
Process and adjust claims related to Optum, Zelis, ClearHealth, Macro/Aetna vendors. 
Demonstrates knowledge and understanding of all plan types and Moda administrative policies affecting claims processing and adjustments.
Process vendor payments on a timely basis.
Act as a contact person for Optum TruClaim inquiries both internally and externally.
Provide back-up for other Optum, ClearHealth and Zelis staff members.
Identify and refer trends in the system and procedures and recommend improvements to increase efficiency and reduce errors.
Provide training as indicated by Supervisor.
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.
Inside the company with Claims, Medical Customer Service, Accounting, Sales & Service, Membership Accounting, Benefit Configuration, Information Technology, and Professional Relations. Outside the company 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 & Danielle Baker via our humanresources@modahealth.com email.]]></description>
      <pubDate>Sun, 19 Apr 2026 00:00:00 EDT</pubDate>
    </item>
    <item>
      <title><![CDATA[Medicaid Provider Relations Rep II - Portland, OR]]></title>
      <link>https://ejob.bz/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://ejob.bz/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://ejob.bz/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>
</rss>

