Compare your current skills to what this opportunity needs—we'll show you what you already have and what could strengthen your application.
Job Description
Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America's heartland.
Work Shift:
8 Hours - Day Shifts (United States of America)
Scheduled Weekly Hours:
40
Compensation:
Union Position:
No Department Details This position allows some work from home options as well as a flexible schedule Summary The Claims Manager is under the general supervision of the Sanford Health Plan Director of Claims, in the areas of health insurance claims submitted by providers and patients for processing. Job Description Responsible for the implementation and day-to-day performance of process activities related to claims research and resolution. The process includes the review and/or testing of claims, benefits and fee schedules to ensure claims process correctly. Accountable as a resource to all employees in the claims department as well as other departments in the organization. Responsible for the interviewing, hiring, discipline of employees and any other personnel issues that arise. Completes performance appraisals. Coordinates claims processing and adjustment activities within the claims department. Manages claims inventory, ensuring accurate and timely processing. Knowledge of various lines of business that the Sanford Health Plan services and how to differentiate services. Understands the details of professional and institutional claim processing which includes how benefits are assigned and pricing is calculated. Works to help develop and maintain claims policies and procedures. Must communicate effectively with a high level of diplomacy. Demonstrates analytical ability and a good awareness of pertinent details. Assimilates large amounts of information to maintain a broad knowledge base. Exercises good judgement in determining the best method for handling a variety of situations. Maintains good working relationships with staff, physicians, and enrollees. Handles pressure effectively. Maintains confidentiality. Other duties as assigned. Qualifications Bachelor's degree preferred. Three years in a team lead or management role in claims processing or similar environment required. 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 1-877-949-5678 or send an email to talent@sanfordhealth.org. The Sanford organization owns and manages multiple distinct brands, including Sanford Health, Marshfield Clinic, and Good Samaritan, as well as Lewis Drug, Sanford Health Equip, Solutions by Sanford, Great Shots, and Blue Rock Bar & Grill. Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America's heartland. Headquartered in Sioux Falls, South Dakota, the organization has 53,000 employees and serves over 2 million patients and nearly 425,000 health plan members across the upper Midwest including South Dakota, North Dakota, Minnesota, Wyoming, Iowa, Wisconsin and the Upper Peninsula of Michigan. The integrated nonprofit health system includes a network of 56 hospitals, 288 clinic locations, 147 senior care communities, 4,000 physicians and advanced practice providers and nearly 1,500 active clinical trials and studies. The organization's transformational virtual care initiative brings patients closer to care with access to 78 specialties. Learn more about Sanford Health's commitment to shaping the future of rural health care across the lifespan at sanfordhealth.org or Sanford Health News. Good Samaritan, one of the nation's largest nonprofit providers of senior care and services, is committed to transforming the aging experience through innovation, compassion and personalized care. As part of Sanford Health, an integrated nonprofit health system headquartered in Sioux Falls, South Dakota, Good Samaritan serves 10,000 seniors and offers access to a full continuum of care, including 94 rehabilitation and skilled nursing centers, 56 assisted living and memory care facilities, 44 independent living locations and 37 home health and hospice agencies. The senior care provider delivers services across the upper Midwest, with 70% of residents living in rural communities. Learn more about Good Samaritan's mission and commitment to delivering high quality senior care in rural America at good-sam.com.
