Senior Claims Advocate

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 open to a remote, hybrid or in-office working arrangement out of the Fargo, ND office. We empower our employees to find a work style that is best for them. Learn more at Life at Blue | BCBSND.

Pay information

• Pay Level: 017
• FLSA Category: Nonexempt – Hourly
• Individual pay will be based on skills, experience, qualifications, location, internal equity, and other relevant factors.
• Opportunities for continued salary growth through a performance-based merit program.

A day in the life

The Senior Claims Advocate is responsible for reviewing complex health insurance claims and inquiries and determining whether to return, deny, or pay claims following organizational policies and procedures.

Your responsibilities will include 

• Reviews claim inquires 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.
• Initiates requests to update member information, when necessary.
• Achieves and maintains a clear understanding of all systems, applications, and procedures necessary to identify denial codes, edits, and processing codes pertaining to all claims in order to process claims correctly. 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.
• Performs work under minimal supervision. Handles complex issues and problems and refers more complex issues to higher-level staff.
• Coaches and mentor’s department staff and collaborates with leadership to support strategic goals within the team.

What you need to succeed 

• A High School Diploma/GED
• 5 years of claims processing, insurance, or related experience. 
• Be a problem solver with the ability to research, analyze and define methods, practices, and procedures to resolve issues.
• Consistently maintains a high level of productivity.
• Organized and proficient in collecting data with the ability to prioritize in a changing environment.
• Clearly communicate and support employees in a variety of situations, while also being flexible and adaptable.
• 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.

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 careers@bcbsnd.com.

This job posting will be closed 2/7/2025 at 8:00 a.m. (CT). No further applications will be considered.

Salary : $200