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Job Description
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Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We’re proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.
Facility: Fargo Health Plan
Location: Fargo, ND
Address: 1749 38th St S, Fargo, ND 58103, USA
Shift: 8 Hours – Day Shifts
Job Schedule: Full time
Weekly Hours: 40.00
Job Summary
Demonstrates excellent customer service while partaking in inbound and outbound calls for Sanford Health Plan, ensuring a positive experience for all members. Oversees member issues, questions, concerns and ensures a resolution is found. Responds to members and providers in a polite and courteous manner, with patience, empathy, care, compassion and sincerity in voice, tone and pace. Responds to customer questions via telephone and written correspondence regarding insurance benefits, provider networks, eligibility and claims. Operates appropriate software systems to obtain and extract information, documenting information, activities and changes in the database.
Explains member rights and responsibilities in accordance with contract. Processes claim adjustment requests. Thoroughly documents inquiries for accurate tracking and analysis. Coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner. Researches and analyzes data to address operational challenges and customer service issues. Serves as an advisor, going above and beyond for members, creating a memorable experience and providing expert, proactive service.
Handles incoming requests for complaints and appeals. Performs reviews of member claims history to ensure accurate tracking of benefit maximums. Assists members with medical and pharmacy benefits, claims processing and status and locating and assisting with the appropriate prior authorization requirements. Consistently meets established productivity, schedule adherence, meeting metric expectations and quality audit standards.
Expected to comply with other job-related responsibilities as assigned by management. Additional responsibilities may include, but are not limited to making outbound follow calls to members, data processing, system upgrade testing, identifying and reporting potential workflow discrepancies and inefficiencies. Exhibits critical thinking skills while being perceptive to the needs of all members.
Demonstrates empathy, understanding, compassion and kindness to all visitors, customers or patients/family members regardless of race, color and culture, socio-economic, or physical or emotional condition. Possess excellent communication skills and be able to interact in a supportive, positive manner, acknowledging the level of importance and sensitivity for those visiting the facility while remaining composed under pressure. Responds with empathy and strong interpersonal skills. Must remain calm and provide reassurance regardless of situation. Must have a positive attitude, the ability to learn quickly and adapt easily to change.
Qualifications
High school diploma or equivalent preferred.
One year of office experience with exposure to customer relations and computer data input preferred. Medical Terminology knowledge preferred. Insurance experience preferred. Medicare and Medicaid billing knowledge preferred.
Benefits
Sanford Health offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, sick leave and paid time off. To review your benefit eligibility, visit https://sanfordhealth.jobs/benefits .
Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to [email protected] .
Sanford Health has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.
Job Function: Health Plan
Req Number: R-72749
Featured: No
