Claims Service Advocate (SAT) (Remote)

Blue Cross Blue Shield Association • Fargo, ND

407d • Remote

About The Position

The Claims Service Advocate is responsible for reviewing moderately complex health insurance claims and providing customer service to members, providers, and customers. This role involves determining how to apply benefits and making decisions on claims based on organizational policies and procedures. The position allows for remote, hybrid, or in-office work arrangements, empowering employees to choose their preferred work style.

Requirements

• High School Diploma/GED
• 3 years of Customer service, Claims Processing or related experience
• Ability to resolve problems, make suggestions and implement process improvements
• Pays close attention to the details of all work and strives for a high level of accuracy
• Responds quickly to change and easily considers new approaches
• Makes customers/clients' needs a primary focus of attention
• Demonstrates active listening in contacts with others
• Ability to communicate verbally or in writing with individuals and groups to deliver or exchange information

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.
• 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 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
• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED