Sanford Health Associate Claims Representative - Claims in Fargo, North Dakota
Job Title: Associate Claims Representative | Claims | Fargo
Department : Claims - Fargo
Job Schedule: Full Time
Hours Per Shift: 8 hr
Responsible for processing health insurance claims submitted via paper or electronically by providers and members.
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 leadership staff. 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. Basic knowledge of Microsoft Office. Other duties as assigned.
Follows all steps of the claims adjustment process according to standards and guidelines.;Addresses documentation issues to support claim processing that is in-line with regulations and rules.;Utilizes major tools and techniques for processing claims, from claims receiving to compensation releases.;
General Education Diploma (GED) or High School diploma required; some college level course work preferred.
A minimum of one year of medical 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 1-877-673-0854 or send an email to firstname.lastname@example.org .
Job Function: Health Plan
Job Schedule: Full Time
Req Number: WD08708