Associate Claims Representative

🕒 5 days 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

🛡️ Insurance

🏥 Healthcare

⚕️ Healthcare Insurance

Insurance • Healthcare • 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

• Process health insurance claims submitted by providers and members via paper or electronically • Release health insurance claims for payment according to defined workflows • Validate claims based on health insurance cost sharing, limitations, and exclusions • Review claims for completeness and accuracy • Apply medical necessity and eligibility guidelines to determine coverage • Work assigned pend and error reports • Determine benefit levels according to summary plan language • Prepare requests for additional information as needed • Respond to information requests from other Sanford Health Plan departments • Refer complex claims to Senior and/or Lead Claims Representatives • Monitor maximum out-of-pocket expenses using accumulators • Perform other duties as assigned

🎯 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 preferred • Analytical ability and keen attention to detail • High degree of accuracy in work • Demonstrable computer literacy • Desire to learn and perseverance in completing work • Ability to maintain confidentiality • Basic knowledge of Microsoft Office