Sanford Health je integriran sistem zdravstvenega varstva in zdravstvenega zavarovanja, ki oskrbuje skupnosti po osrednjem delu Združenih držav Amerike. S sedežem v mestu Sioux Falls v Južni Dakoti podpira več kot 1,4 milijona pacientov in skoraj 200.000 članov zdravstvenih načrtov prek obsežne mreže zdravstvenih centrov, klinik, skupnosti za starejše, zdravnikov in izvajalcev napredne zdravstvene oskrbe. Njegovo delo obsega neposredno oskrbo pacientov, zavarovanje, klinične raziskave in personalizirano genetsko medicino, s specializiranimi programi na področjih, kot so onkologija, ortopedija, zdravje žensk in genetika.
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.
Opis
- 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
Zahteve
- 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