Sanford Health Associate Claims Representative - Claims in Sioux Falls, South Dakota

Job Title: Associate Claims Representative | Claims | Sioux Falls

City: Sioux Falls

State: South Dakota

Department : Claims

Job Schedule: Full Time

Shift: Days

Hours Per Shift: 8 hr

JOB SUMMARY

Accountable to the Health Plan Claims Manager in the areas of health insurance claims submitted via paper or electronically by providers and Sanford Health Plan Members for processing. Responsible for keying paper health insurance claims, understanding of health insurance cost sharing, limitations, exclusions and state mandates. Review claims for completeness and accuracy, applying medical necessity/eligibility guidelines to determine coverage, working assigned pend and error reports, determining the benefit level to be paid according to the Plan language, releasing health insurance claims for payment, preparing requests for additional information as needed. Responding promptly to request for information from other Sanford Health Plan departments. Referring complex claims to leadership staff.

POSITION RESPONSIBILITIES

Analytical ability and ability to give attention to detail. A high degree of accuracy in work. Perseverance in completing work. Desire to learn. Must have demonstrable computer literacy. Type a minimum of 40 wpm.

QUALIFICATIONS

GED or High School diploma required; some college level course work preferred. A minimum of one (1) year of Health Plan claims processing experience is preferred.

About Sanford Health:

At Sanford Health, we are dedicated to the work of health and healing. Every day, we show that commitment by delivering the highest quality of care to the communities we serve. We are leaders in health care and strive to provide patients across the region with convenient access to expert medical care, leading-edge technologies and world-class facilities.

In addition to strong clinical care, we are also committed to research, education and community growth. We engage in medical research to not only discover innovative ways to provide care, but also cures for common diseases. We continuously seek new ways to achieve our vision of improving the human condition here in your community, across the region and around the world.

The entire team at Sanford Health recognizes the value of healthy families and communities. We continue to gain momentum and expand our reach. Together, we can make a positive difference now, and in the future.

Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-243-1372 or send an email to talent@sanfordhealth.org .

In compliance with federal law requiring employers to verify new employees' U.S. employment eligibility, Sanford participates in E-Verify. To learn more click here for English Version at https://e-verify.uscis.gov/emp/media/resourcesContents/EverifyPosterEnglish.pdf or here for Spanish Version at https://e-verify.uscis.gov/emp/media/resourcesContents/EverifyPosterSpanish.pdf .

City: Sioux Falls

State: South Dakota

Job Function: Health Plan

Job Schedule: Full Time

Shift: Days

Req Number: req8591