Associate Claims Representative

Job Summary

Responsible for processing health insurance claims submitted via paper or electronically by providers and members. Ability to release health insurance claims for payment according to the defined workflows. Validates health insurance claims with an understanding of health insurance cost sharing, limitations, and exclusions. Reviews claims for completeness and accuracy, apply medical necessity and/or eligibility guidelines to determine coverage, work assigned pend and error reports, determine the benefit level to be paid according to the summary plan language, release health insurance claims for payment, and prepare requests for additional information as needed. Responds promptly to requests for information from other Sanford Health Plan departments. Refers complex claims to Senior and/or Lead Claims Representatives.

Qualifications

• High school diploma or equivalent required.
• Some college level course work preferred.
• One year of applicable experience required.
• A minimum of one year of medical claims processing experience is preferred.

Benefits

Sanford offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home-work balance.

About the Role

Flexible schedule

Skills

Requires analytical ability and keen attention to detail with a high degree of accuracy in work. Understands accumulators for accurate monitoring of maximum out of pocket expenses for claims processing. Must have demonstrable computer literacy. Perseverance in completing work with a desire to learn is necessary. Must maintain confidentiality. Basic knowledge of Microsoft Office.

Pay

$15.00 - $23.00

Schedule

Full time

Benefits

Sanford has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.