- Utilizes various systems and process guidelines to review, process, and adjudicate moderately complex claims, ensuring quality and timeliness standards are met.
- Reviews moderately complex claim inquires by analyzing, interpreting, and researching the request to determine appropriate action. Initiates any requests to update member information, when necessary.
- Responds to incoming reports, medical records, and other related documents to make claim determinations for additional processing.
- Provides information, guidance, and education to members and customers in complex and escalated situations while working in close partnership with other internal departments to ensure customer satisfaction.
- Conducts research on behalf of members, providers, and customers, which may include the review of documents, statements and information supplied by other outside agencies.
- High School Diploma or GED with at least 3 years of experience of customer service or related experience.
- Resolves problems, makes suggestions and implements process improvements.
- Pays close attention to the details of all work and strives for a high level of accuracy.
- Meets or exceeds customer expectations.
- Possesses strong communication skills, both written and verbal.
- Wellness incentives including well-being lifestyle spending accounts, employee assistance program and employee discounts.
- Encouraged paid time off including paid holidays and flexible holidays to use as you wish.
- 16 hours of paid volunteer time with a $200 donation to a charity of your choice upon completion of all volunteer hours.
- Employee recognition, community initiative events and yearly company outings.
- Workplace flexibility offering different options for working arrangements and the freedom to make time for important commitments.
- Our core benefits include health, dental, vision and life insurance, short-term and long-term disability and paid parental leave.
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Claims Service Advocate - Fargo, United States - Blue Cross Blue Shield of North Dakota
Description
All about us
You likely know us as an insurance company, but that's just a portion of what we do. Hundreds of thousands of North Dakotans trust us to provide them with personalized service and unmatched access to care. It's a mission we take seriously.
We also work with entities throughout the state to challenge the cost and complexity of health care in North Dakota. This uncompromising goal requires caring, innovative people who are ready and willing to help create a new level of health and well-being in North Dakota and beyond.
Work environment
This opportunity is eligible for remote work or a hybrid work arrangement. We empower our employees to find a work style that is best for them. Learn more at .
This position is eligible for internal and external applications.
Pay information
Pay Level: 016
FLSA Category: Non-Exempt-Hourly
A day in the life
The Claims Service Advocate is responsible for reviewing moderately complex health insurance claims and provides customer service to members, providers, and/or customers by telephone, computers, and/or written inquiry. This position determines how to apply benefits and whether to return, deny, or pay claims following organizational policies and procedures.
Your responsibilities will include
What you need to succeed
Equivalent combination of education, experience or training determined to be acceptable by Human Resources may be substituted, unless regulated by contract or program standards
Benefits and perks
Equal opportunity employment
Equal Opportunity Employer of Minorities, Females, Protected Veterans and Individual with Disabilities, as well as Sexual Orientation or Gender Identity.
For questions, please email .
This job posting will be closed 5/9/2024 at 8:00 a.m. (CT). No further applications will be considered.
Equal Opportunity Employer/Protected Veterans/Individuals with DisabilitiesThe contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR c)
