Claims Service Advocate (FEP)

Blue Cross Blue Shield North Dakota•Fargo, ND

4d•Remote

About The Position

This position is responsible for reviewing moderately complex health insurance claims and providing customer service to members, providers, and/or customers via telephone, computer, and/or written inquiry. The role determines how to apply benefits and whether to return, deny, or pay claims following organizational policies and procedures. The company is an insurance provider that also works with state entities to address healthcare costs and complexity in North Dakota. They have a strategic affiliation with Cambia Health Solutions, effective February 1, 2026, which aims to improve access to simpler, more affordable healthcare while maintaining a local focus. Under this affiliation, BCBSND employees became Cambia employees but continue to serve the BCBSND market, with day-to-day work and hiring proceeding as usual.

Requirements

A High School Diploma/GED
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.

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 inquiries 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.

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.
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.