Associate Claims Representative

Role Overview

• Responsible for processing health insurance claims submitted via paper or electronically by providers and members
• Validates health insurance claims with an understanding of health insurance cost sharing, limitations, and exclusions
• Reviews claims for completeness and accuracy
• Releases health insurance claims for payment according to the defined workflows
• Works assigned pend and error reports
• Determines 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
• Basic knowledge of Microsoft Office

Benefits

• Health insurance
• Retirement plans