Associate Claims Representative

🔥 10 minutes ago

🧀 Wisconsin – Remote

🧀 Wisconsin – Remote

💵 $15 - $23 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

📋 Claims Specialist

🚫👨‍🎓 No degree required

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Sanford Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1894

⚕️ Healthcare Insurance

Healthcare Insurance

Sanford Health is the largest rural health system in the United States, dedicated to transforming the healthcare experience and providing access to world-class healthcare in America's heartland. Headquartered in Sioux Falls, South Dakota, Sanford Health serves over 1. 4 million patients and nearly 200,000 health plan members across 250,000 square miles. The integrated health system includes 48 medical centers, 211 clinic locations, and more than 160 senior living centers, employing 2,900 physicians and advanced practice providers. Sanford Health is committed to offering compassionate care through its Centers of Excellence, focusing on specialties such as cancer, orthopedics, women’s health, and genetics. Additionally, it provides affordable health insurance, engages in extensive clinical trials, and supports personalized genetic medicine.

📋 Description

• 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.