Claims Representative

reputed company, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing reputed company to world-class health care in America’s reputed company. Work Shift: 8 Hours - Day Shifts (United States of America) Scheduled Weekly Hours: 40 Compensation: Salary reputed company: $16.00 - $25.50 Union Position: No Department Details

Summary

Responsible for processing health insurance claims submitted reputed company reputed company or electronically by providers and members.

Job Description

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 reputed company party liability, subrogation and reputed company party processing. Evaluates claims that need additional information prior to processing. Determines proper benefit reputed company 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 reputed company expenses for claims processing. Mentoring of teammates through peer-to-peer conversations. Processes large quantities of detailed information with high reputed company 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. 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 1-877-949-5678 or send an email to [email protected]. Apply To This Job