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Sanford HealthSH

Claims Representative

Sanford Health is the largest rural health system in the U.S., dedicated to transforming healthcare access and quality for over 1.4 million patients annually.

Sanford Health

Employee count: 5000+

United States only

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Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America’s heartland.

Work Shift:

8 Hours - Day Shifts (United States of America)

Scheduled Weekly Hours:

40

Compensation:

Salary Range: $16.00 - $25.50

Union Position:

No

Department Details

Summary

Responsible for processing health insurance claims submitted via paper 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 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.

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 talent@sanfordhealth.org.

About the job

Apply before

Posted on

Job type

Full Time

Experience level

Location requirements

Hiring timezones

United States +/- 0 hours

About Sanford Health

Learn more about Sanford Health and their company culture.

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Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America's heartland. Headquartered in Sioux Falls, South Dakota, the organization serves more than 1.4 million patients and nearly 200,000 health plan members across an area of 250,000 square miles. The integrated health system boasts 48 medical centers, more than 211 clinic locations, and over 160 Good Samaritan Society senior living centers. With approximately 42,775 employees, including 2,900 physicians and advanced practice providers, Sanford Health is equipped to deliver exceptional care across a wide range of specialties.

Sanford Health is committed to advancing the human condition through innovative care solutions, research, and education. The organization operates nine world clinic locations and is involved in numerous active clinical trials aimed at improving healthcare delivery and outcomes. Each year, Sanford Health provides millions of outpatient visits and emergency services, affirming its role as a critical health provider in the upper Midwest. Its Centers of Excellence focus on key areas such as cancer treatment, heart health, and pediatric care, ensuring that communities have access to specialized services. Throughout its history since its founding in 1894, Sanford Health has been a beacon of hope and healing, dedicated to enhancing the health and well-being of the individuals and families it serves.

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Sanford Health

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