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Subrogation Claims Representative

Employer
Blue Cross Blue Shield of ND
Location
Fargo, ND
Salary
Join our team!

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Job Details

The Subrogation Claims Associate is responsible for the research and determination of member claims that may be categorized as subrogation or no-fault for all private business. This position answers calls, researches member claims and collaborates with members and various insurance companies to provide support, gather information for determinations processes establishes the correct source for member coverage. This role provides training and support to department staff and management, in addition to creating payment logs that detail the exchange of claim payouts to support legal and future audits.

Essential Functions

  • Investigates accident-related claims, communicates with external insurance organizations on claim settlement statuses and prepares investigative logs containing claims processing history for legal and auditing purposes.
  • Provides training and coaching for the team about new and updated guidelines that affect the department. Prepares documentation for training about new system releases, updates and testing for the department.
  • Reviews correspondence to determine the next appropriate action needed. Processes claim adjustments and resolves forms of overpayment recovery. Uses research to process and resolve provider and customer questions with varying complexities then generates communication about claim status.
  • Identifies which claims can be fully processed or need additional information, investigates alternative coverage information through collaboration with external parties and utilizes organizational guidelines and reference materials to process claims appropriately.
  • Monitors system generated reports used to complete tasks and ensures department timeliness and performance standards are met.
  • Documents and prepares audit reports for accuracy, timeliness, or system issues in order identify patterns within the system, or patterns of behavior resulting in ongoing accuracy or timeliness concerns.

Requirements

Knowledge, Skills and Abilities

Decision Making

Basic

Research and Data Analysis

Basic

Attention to Detail and Accuracy

Intermediate

Communication (Verbal/Written)

Basic

Prioritization and Organization of Work

Basic

Customer Interaction

Basic

Education Requirements

Required: High School Diploma/GED

Preferred: High School Diploma/GED

Field(s) of Study: N/A

Experience Requirements

Required: Minimum of 1 Year

Preferred: Minimum of 1 Year

Experience Details: Minimum of 1 year of healthcare, insurance, customer service or related experience is required.

Equivalent combination of education, experience or training determined to be acceptable by Human Resources may be substituted, unless regulated by contract or program standards

Other Information

Job Posting Policy 6.05

New employees with Blue Cross Blue Shield of North Dakota will be eligible to apply for positions within their assigned department after successfully completing a 90-day review. For positions outside your department, you must attain a minimum of six months of service before you can apply.

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 11/26/18 at 8:00AM CST. No further applications will be considered.

Company

TWO WORDS – MEMBERS FIRST.

That sums up why we’re here. And according to member satisfaction surveys, 95.6% say we’ve done a great job at maintaining that focus.

With that said, there are still mountains to move. America’s health care system needs an overhaul and Blue Cross Blue Shield of North Dakota is taking a lead role. To accomplish that, we need BOLD people who believe they can make an impact.

Are you ready to shake up an industry?

If you’re passionate about taking on our nation’s number one health care concern, there may be a place for you on one of our teams.

Company info
Website
Location
4510 13th Ave. S.
Fargo
ND
58103
United States

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