Moda Health Claims & Customer Service Trainer II in Portland, Oregon

Claims & Customer Service Trainer II

Job Title

Claims & Customer Service Trainer II


Open Until Filled





Other Location

Job Class - P11/109


Let’s do great things, together Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together. Currently, Moda Health is seeking a Trainer to join our Medical Claims/Customer Service Department. As a Trainer, you will be responsible in providing training, develop and maintain documentation, and perform quality reviews of policies, procedures, phone techniques and etiquette and system functionality. Retrain and provides ongoing training to claims and customer service or other departments as needed. Ensure consistent application of administrative policies and efficient system usage is followed. Assist the supervisor in developing new trainers and/or trainees. Primary Functions:1. Access training needs in development of new training programs.2. Develops courses and modules for use in the training of all levels of processors. This includes the development and updating of course content and training materials including but not limited to contract, claims, and phone skill modules. Coordinates to ensure consistency throughout the corporation.3. Presentations are developed and implemented in a clear, user-friendly manner and accommodate various adult learning skills.4. Conducts end of course evaluation and action planning.5. Create and update documentation and resource materials as needed.6. Ensure departmental quality assurance standards are adhered through phone monitoring, adjustment auditing, etc.7. Advise the supervisor of any personnel issues, utilizing proper judgment in accessing any necessary action to be taken.8. Assist in planning, organizing and directing the activities and workflow of the department.9. Participate in or manage projects as assigned.10. Responsible for quality and continuous improvement within the job scope.11. Contributes to and supports the corporation‘s quality initiatives by encouraging team and individual contributions toward the corporations quality improvement efforts.12. Fosters an atmosphere of cooperation and team spirit with trainers at all times.13. Collaborating with claims & customer service departments to identify training needs and coordinating and implementing classes when appropriate.14. Travels to other Moda offices, Milwaukie, Bend and La Grande to assist in training and mentor other Trainers.15. Other duties as assigned.Are you ready to be a betterist? If you’re ready to make a difference that matters, we want to hear from you. Because it’s time to discover what’s possible. 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.

Required Skills

  1. High School diploma or equivalent.

  2. At least two years experience as a Claims & CS Trainer consistently exceeding level of performance or equivalent experience with multiple lines of business such as Medical, Dental, Pharmacy and BHS.

  3. Ability to instruct, motivate, direct individuals at various skill levels over the phone, face to face and in the classroom environment.

  4. Demonstrated strong, effective and diplomatic interpersonal skills with employees of all levels and to participate effectively as a team player.

  5. Demonstrated analytical skills in identifying technical needs and implementing an effective course of action.

  6. In dept knowledge of Facts and Facets Extended Enterprise systems.

  7. Excellent oral and written communications.

  8. Demonstrate training skills in small and large groups with good presentation skills.

  9. Knowledge of WORD, EXCEL, PowerPoint and Saba.

  10. Excellent reading, oral and written communication skills and ability to interact professionally, patiently and courteously with customers over the phone and in person.

  11. Excellent problem solving and decision making skills.

  12. Ability to work well under pressure in a complex and rapidly changing environment.

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

  14. Maintain confidentiality and project a professional business appearance.

  15. Knowledge and understanding of Moda administrative policies affecting claims.

  16. Demonstrated ability to handle difficult calls and claim and benefit issues with little assistance.