Sanford Health ir integrēta veselības aprūpes un veselības apdrošināšanas sistēma, kas apkalpo kopienas visā Amerikas vidienē. Tās galvenā mītne atrodas Sūfolsā, Dienviddakotā, un plašs medicīnas centru, klīniku, senioru dzīvesvietu kopienu, ārstu un progresīvās prakses veselības aprūpes speciālistu tīkls nodrošina atbalstu vairāk nekā 1,4 miljoniem pacientu un gandrīz 200 000 veselības plāna dalībnieku. Tās darbība aptver tiešu pacientu aprūpi, apdrošināšanu, klīniskos pētījumus un personalizētu ģenētisko medicīnu. Specializētās programmas ietver tādas jomas kā onkoloģija, ortopēdija, sieviešu veselība un ģenētika.
Associate Health Claims Representative – Sanford Health (Wisconsin Remote)
Process and validate health insurance claims for Sanford Health, applying plan guidelines to determine coverage and payment.
Apraksts
- Process paper and electronic health insurance claims submitted by providers and members
- Release claims for payment through established workflows
- Validate claims against health plan cost-sharing rules, limits, and exclusions
- Check claims for completeness and accuracy
- Apply medical necessity and eligibility guidelines to assess coverage
- Work assigned pending and error reports
- Determine benefit levels using summary plan language
- Request additional information when needed
- Respond to information requests from other Sanford Health Plan departments
- Refer complex claims to senior or lead claims representatives
- Track maximum out-of-pocket expenses using accumulators
- Carry out other assigned duties
Prasības
- High school diploma or equivalent
- At least one year of relevant experience
- Demonstrated computer literacy
- Ability to maintain confidentiality
- Basic knowledge of Microsoft Office
- Analytical skills and close attention to detail, with a high level of accuracy
- Some college coursework preferred
- At least one year of medical claims processing experience preferred