Sanford Health

Associate Claims Representative | Claims

Sioux Falls, South Dakota
Join our team!
Aug 12, 2020
Job Type

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.
See yourself at Sanford!

Facility: Cherapa Place Building

Location: Sioux Falls, SD

Shift: Varies

Job Schedule: Full time

Weekly Hours: 40.00

Job Summary

Responsible for processing health insurance claims submitted via paper or electronically by providers and members. Validates health insurance claims with an understanding of health insurance cost sharing, limitations, and exclusions. Reviews claims for completeness and accuracy, apply medical necessity and/or eligibility guidelines to determine coverage, work assigned pend and error reports, determine the benefit level to be paid according to the summary plan language, release health insurance claims for payment, and prepare requests for additional information as needed. Responds promptly to requests for information from other Sanford Health Plan departments. Refers complex claims to leadership staff. Requires analytical ability and keen attention to detail with a high degree of accuracy in work. Understands accumulators for accurate monitoring of maximum out of pocket expenses for claims processing. Must have demonstrable computer literacy. Perseverance in completing work with a desire to learn is necessary. Basic knowledge of Microsoft Office. Other duties as assigned.

Department Details

Flexible Schedule


General Education Diploma (GED) or High School diploma required; some college level course work preferred.
A minimum of one year of medical claims processing experience is preferred.
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 .

Job Function: Health Plan

Req Number: R-25568

Featured: No