Health Navigator I (Customer Service) - Full-Time Work From Home

About the Role

Moda is hiring a Health Navigator I to support members through phone, email, and online chat. In this role, you’ll help people understand their benefits and health program options by listening to their needs, researching details, and providing accurate, timely responses.

Responsibilities

• Assist members and customers with medical, dental, and/or pharmacy inquiries for assigned Moda groups
• Answer questions related to claims, authorizations, eligibility, and benefit coverage
• Handle inbound requests via phone, email, voicemail, and online chat (and respond through multiple channels)
• Conduct detailed research and complete follow-up with internal teams, providers, and pharmacies as needed
• Use the Moda 360 Navigator Console to review recommended health actions and programs and guide members through next steps
• Document interactions accurately while simultaneously researching questions
• Support resolution for complex or sensitive member issues, including multiple follow-ups until the matter is resolved
• Maintain confidentiality and communicate professionally with members, including those who may be frustrated

Requirements

• High school diploma or equivalent
• Ability to complete Moda Health Customer Service Representative training
• Relevant experience preferred, such as claim processing, customer service, or work in a medical/dental office or pharmacy
• Desire to learn and use medical, dental, and/or pharmacy terminology; diagnosis/procedure coding knowledge is helpful
• Strong written and verbal communication skills with a patient, courteous approach
• Excellent analytical and problem-solving abilities
• 10-key proficiency (105 kpm net) and ability to type at least 25 wpm net
• Comfort working in a fast-paced, changing environment while maintaining strong attendance
• Experience using Microsoft Office tools (Outlook, OneNote, Teams) and ability to work across multiple applications
• Experience with TriZetto Facets is helpful
• Ability to learn independently, take initiative, and continuously improve skills
• Must complete Effortless Experience training and certification after hire

Benefits

• Medical, Dental, Vision, Pharmacy, Life, and Disability coverage
• 401(k) match
• FSA
• Employee Assistance Program
• PTO and company-paid holidays