Sanford Health — Amerikaning markaziy hududlaridagi jamoalarga xizmat ko‘rsatuvchi integratsiyalashgan tibbiy xizmatlar va tibbiy sug‘urta tizimi. Bosh qarorgohi Janubiy Dakota shtatining Syu-Fols shahrida joylashgan tashkilot tibbiyot markazlari, klinikalar, keksalar uchun yashash majmualari, shifokorlar va ilg‘or amaliyot mutaxassislaridan iborat keng tarmog‘i orqali 1,4 milliondan ortiq bemor hamda qariyb 200 000 nafar tibbiy sug‘urta rejasi a’zosini qo‘llab-quvvatlaydi. Uning faoliyati bevosita bemorlarga tibbiy yordam ko‘rsatish, sug‘urta, klinik tadqiqotlar va shaxsiylashtirilgan genetik tibbiyotni qamrab oladi. Shuningdek, tashkilot onkologiya, ortopediya, ayollar salomatligi va genetika kabi yo‘nalishlarda ixtisoslashtirilgan dasturlarni amalga oshiradi.
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.
Tavsif
- 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
Talablar
- 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