Claims Representative
Wisconsin, United States
Full-time
Onsite
1 month ago
About the role
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: $16.00 - $25.50
Job Summary
Responsible for processing health insurance claims submitted via paper or electronically by providers and members. Proficient understanding of Tapestry functionality. Proficient knowledge to releases health insurance claims for payment, understands claims codes according to the defined workflows. Proficient in the processing of claim adjustments based on appeals, configuration and/or benefit change. Basic knowledge of coordination of benefit functions and rules, a basic understanding of third party liability, subrogation and third party processing. Evaluates claims that need additional information prior to processing. Determines proper benefit levels that apply to claims per the certificate of insurance and/or the summary of plan documents. Understands the specific product lines. Understands accumulators for accurate monitoring of maximum out of pocket expenses for claims processing. Mentoring of teammates through peer-to-peer conversations. Processes large quantities of detailed information with high levels of accuracy. Investigates beneath the surface of an issue to focus systematically on root causes; communicates findings with the Senior Claims Representative. Requires analytical ability and keen attention to detail with a high degree of accuracy in work. Must maintain confidentiality. Other duties as assigned.
Qualifications
High school diploma or equivalent required. Associate degree preferred.
Two years of applicable experience required. Two years of medical claims processing experience is preferred. Knowledge of benefits, summary plan documents, certificates of insurance, and explanation of benefits.
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-0258514
Job Function: Health Plan
Featured: No
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: $16.00 - $25.50
Job Summary
Responsible for processing health insurance claims submitted via paper or electronically by providers and members. Proficient understanding of Tapestry functionality. Proficient knowledge to releases health insurance claims for payment, understands claims codes according to the defined workflows. Proficient in the processing of claim adjustments based on appeals, configuration and/or benefit change. Basic knowledge of coordination of benefit functions and rules, a basic understanding of third party liability, subrogation and third party processing. Evaluates claims that need additional information prior to processing. Determines proper benefit levels that apply to claims per the certificate of insurance and/or the summary of plan documents. Understands the specific product lines. Understands accumulators for accurate monitoring of maximum out of pocket expenses for claims processing. Mentoring of teammates through peer-to-peer conversations. Processes large quantities of detailed information with high levels of accuracy. Investigates beneath the surface of an issue to focus systematically on root causes; communicates findings with the Senior Claims Representative. Requires analytical ability and keen attention to detail with a high degree of accuracy in work. Must maintain confidentiality. Other duties as assigned.
Qualifications
High school diploma or equivalent required. Associate degree preferred.
Two years of applicable experience required. Two years of medical claims processing experience is preferred. Knowledge of benefits, summary plan documents, certificates of insurance, and explanation of benefits.
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-0258514
Job Function: Health Plan
Featured: No
Skills
Hospitals and Health Care