Senior Claims Advocate (Medicaid Expansion)

Blue Cross Blue Shield of North Dakota
Fargo, ND
Category Insurance
Job Description
We are seeking a Senior Claims Advocate to review complex health insurance claims and inquiries, determining whether to return, deny, or pay claims following organizational policies and procedures. The ideal candidate will have a high school diploma, at least 5 years of experience in claims processing, insurance, or related work, and excellent attention to detail and problem-solving skills.

Requirements

  • Reviews claim inquiries by analyzing, interpreting, and researching the request to determine appropriate action.
  • Utilizes various systems and process guidelines to review, process, and adjudicate claims, ensuring quality and timeliness standards are met.
  • Responds to incoming reports, medical records, and other related documents to make claim determinations for additional processing.
  • Performs research on claims history, contract benefits, or other relevant documentation to process outstanding claims and make determinations on how to move the claim through the process.
  • Coaches and mentors department staff and collaborates with leadership to support strategic goals within the team.

Benefits

  • Affordable medical, dental and vision coverage accepted throughout the United States
  • Employer funded Lifestyle Spending Accounts and Health Savings Accounts
  • 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
  • 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
]]>