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Associate Claims Representative
Location
Wisconsin
Posted
6 days ago
Salary
$15 - $23 / hour
Seniority
Mid Level
Job Description
Associate Claims Representative
Sanford Health
• 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.
Job 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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