Overview
**Careers With Purpose**
**Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We’re proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.**
**Facility:** 45th St Business Center
**Location:** Fargo, ND
**Address:** 300 45th St S, Fargo, ND 58103, USA
**Shift:** 8 Hours – Day Shifts
**Job Schedule:** Full time
**Weekly Hours:** 40.00
**Salary Range:** $16.00 – $25.50
**Department Details**
Position has the potential for a flexible work schedule. After successful initial training period, there may be a opportunity to work from home.
**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 Health 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 talent@sanfordhealth.org .
Sanford Health 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-0194846
**Job Function:** Health Plan
**Featured:** No
