Claims Representative

Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America’s heartland. Work Shift 8 Hours - Day Shifts (United States of America) Scheduled Weekly Hours 40 Compensation Salary Range $16.00 - $25.50 Union Position No Department Details Summary Responsible for processing health insurance claims submitted via paper or electronically by providers and members.

Job Description

Proficient understanding of Tapestry functionality. Proficient knowledge to releases health insurance claims for payment, understands claims codes according to the defined workflows. Proficient in the processing of claim adjustments based on appeals, configuration and/or benefit change. Basic knowledge of coordination of benefit functions and rules, a basic understanding of third party liability, subrogation and third party processing. Evaluates claims that need additional information prior to processing. Determines proper benefit levels that apply to claims per the certificate of insurance and/or the summary of plan documents. Understands the specific product lines. Understands accumulators for accurate monitoring of maximum out of pocket expenses for claims processing. Mentoring of teammates through peer-to-peer conversations. Processes large quantities of detailed information with high levels of accuracy. Investigates beneath the surface of an issue to focus systematically on root causes; communicates findings with the Senior Claims Representative. Requires analytical ability and keen attention to detail with a high degree of accuracy in work. Must maintain confidentiality. Other duties as assigned.

Qualifications

High school diploma or equivalent required. Associate degree preferred. Two years of applicable experience required. Two years of medical claims processing experience is preferred. Knowledge of benefits, summary plan documents, certificates of insurance, and explanation of benefits. 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 1-877-949-5678 or send an email to [email protected]. Apply To This Job