Sanford Health Associate Claims Representative - Claims in Fargo, North Dakota

Job Title: Associate Claims Representative | Claims | Fargo

City: Fargo

State: North Dakota

Department : Claims

Job Schedule: Full Time

Shift: Days

Hours Per Shift: Other

JOB SUMMARY

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.

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

High School diploma or GED 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 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: Fargo

State: North Dakota

Job Function: Health Plan

Job Schedule: Full Time

Shift: Days

Req Number: req19915