Associate Claims Representative

sanford; United States; On-site; USD 21,000 - 32,000; Full time

Job summary

Sanford Health Plan seeks a qualified Health Insurance Claims Processor to handle processing of claims submitted by providers and members, via paper or electronic means. The role requires applying medical necessity and eligibility guidelines, ensuring accuracy, and maintaining confidentiality.

Responsibilities include releasing claims for payment, verifying accumulators for out-of-pocket limits, and coordinating with other departments.

Qualifications

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

Responsibilities

• Process health insurance claims for payment per defined workflows.
• Validate claims for completeness, accuracy, and cost sharing guidelines.
• Release claims for payment and handle requests for information.

Skills

Analytical ability

Attention to detail

Education

High school diploma or equivalent

Some college coursework

Tools

Microsoft Office

Job description

Work Shift:

8 Hours - Day Shifts (United States of America)

Scheduled Weekly Hours:

40

Compensation:

Salary Range: $15.00 - $23.00

Union Position:

No

Summary

Responsible for processing health insurance claims submitted via paper or electronically by providers and members.

Job Description

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. 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. Other duties as assigned.

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.

EEO Information

Sanford is an EEO/AA Employer M/F/Disability/Vet.

Accommodation Support

If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-949-5678 or send an email to [e-mail].