Associate Claims Representative
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Job Description
Processing health insurance claims for Sanford Health's rural health system, ensuring accuracy and eligibility according to guidelines. Collaborating with other departments for information requests and complex claims.
Responsibilities:
- 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.
- Responds promptly to requests for information from other Sanford Health Plan departments.
- Refers complex claims to Senior and/or Lead Claims Representatives.
Requirements:
- 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.
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