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Associate Claims Representative
Remote · USFull-time$15–23/hrSeen 1w agoSeen in employer's feed 1w ago
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Job overview
The Associate Claims Representative processes health insurance claims submitted by providers and members, validates claims against cost-sharing rules, limitations, exclusions, and plan language, and releases eligible claims for payment. The role reviews claims for accuracy, applies medical necessity and eligibility guidelines, handles pending and error reports, and requests additional information. Complex claims are referred to senior or lead representatives.
Skills & qualifications
Skills
Qualifications
Benefits
Full job description
Careers With Purpose
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.
Facility: Remote WI Location: Remote, WI Address: Shift: 8 Hours - Day Shifts Job Schedule: Full time Weekly Hours: 40.00 Salary Range: $15.00 - $23.00
Job Summary
Responsible for processing health insurance claims submitted via paper or electronically by providers and members. 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.
Benefits
Sanford offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home-work balance. For more information about Total Rewards, visit https://sanfordcareers.com/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 1-877-673-0854 or send an email to [email protected] .
Sanford has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.
Req Number: R-0274895 Job Function: Health Plan Featured: No
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