Claims Service Advocate (FEP)
About the position 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. 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.
Responsibilities
- Utilizes various systems and process guidelines to review, process, and adjudicate moderately complex claims, ensuring quality, accuracy, 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.
- Handles incoming and outgoing customer service calls in a clear and concise manner.
- Performs work under general supervision.
- Handles moderately complex issues and refers more complex issues to higher-level staff.
Requirements
- A High School Diploma/GED along with 3 years of experience in customer service, claims processing or related experience.
- Be a problem solver with the ability to research, analyze and define methods, practices, and procedures to resolve issues.
- Ability to communicate clearly and professionally in both verbal and written formats.
- Ability to work effectively with others, valuing diverse perspectives and fostering teamwork.
- Brings a creative mindset and a go-get-em’ attitude to find ways to improve upon processes and projects.
- A strong ability to prioritize and organize work with varying timelines for projects and daily work.
- 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
- Affordable medical, dental and vision coverage accepted throughout the United States
- Employer funded Lifestyle Spending Accounts, Health Savings Accounts and Health Reimbursement Arrangements
- Employer-paid life and disability insurance
- 401(k) retirement plan with company match and immediate vesting
- Paid holidays, paid time off (PTO), PTO donation program, and paid parental leave
- Voluntary benefits including Accident, Hospital Indemnity, Critical Illness, Term/Whole Life, Cancer Care Insurance, and more.
- Additional company perks
- Robust mental health offerings including an Employee Assistance Program, Learn to Live, meQ.
- Comprehensive learning and development opportunities and an Educational Assistance Program.
- 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.
- Opportunities to connect through employee committees.
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