Senior Claims Advocate (Medicaid Expansion)

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 eligible for remote work or a hybrid work arrangement. We empower our employees to find a work style that is best for them. Learn more at .

This position is eligible for internal Blue Cross Blue Shield employees and external applications.

Pay information

Pay Level: 015

FLSA Category: Non-Exempt-Hourly

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

• High school diploma or GED with at least 5 years of experience in claims processing, insurance or related experience is required.
• Pays close attention to the details of all work and strives for a high level of accuracy.
• Manages time effectively.
• Organize and develop data to respond to requests.
• Ability to resolve problems, make suggestions and implement process improvements.
• Communicates effectively with internal and external stakeholders.
• Responds positively to a changing environment while maintaining work efficiency.

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 and perks

• Wellness incentives including well-being lifestyle spending accounts, employee assistance program and employee discounts.
• Encouraged paid time off including paid holidays and flexible holidays to use as you wish.
• 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.
• Our core benefits include health, dental, vision and life insurance, short-term and long-term disability and paid parental leave.

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 .

This job posting will be closed 9/5/2023 at 8:00 a.m. (CT). No further applications will be considered.