Associate Claims Representative

Sanford Health

. Process health insurance claims submitted via paper or electronically by providers and members .

Posted 10/13/2026full-timeRemote • Wisconsin • United StatesJuniorMid-Level💰 $15 - $23 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in health insurance claims processing, including validation, review, and adherence to medical necessity guidelines. Proficient in maintaining confidentiality and accuracy while managing claims and responding to departmental inquiries.

Highest-signal resume keywords

Health Insurance Claims ProcessingMedical Necessity GuidelinesAnalytical AbilityAttention to DetailMicrosoft Office

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Claims ValidationClaims ReviewBenefit Level DeterminationCost Sharing KnowledgeEligibility Guidelines

Soft Skills

Confidentiality MaintenanceCommunication SkillsProblem-Solving Ability

Industry Keywords

Health InsuranceClaims ProcessingOut-of-Pocket ExpensesAccumulatorsError Reports

About the role

Key responsibilities & impact

Process health insurance claims submitted via paper or electronically by providers and members
Release health insurance claims for payment according to defined workflows
Validate claims using knowledge of health insurance cost sharing, limitations, and exclusions
Review claims for completeness and accuracy
Apply medical necessity and/or eligibility guidelines to determine coverage
Work assigned pend and error reports
Determine benefit levels according to summary plan language
Prepare requests for additional information as needed
Respond to information requests from other Sanford Health Plan departments
Refer complex claims to Senior and/or Lead Claims Representatives
Monitor maximum out-of-pocket expenses using accumulators
Perform other duties as assigned

Requirements

What you’ll need

High school diploma or equivalent required
One year of applicable experience required
Demonstrable computer literacy
Ability to maintain confidentiality
Basic knowledge of Microsoft Office
Analytical ability and keen attention to detail with a high degree of accuracy
Some college level course work preferred
A minimum of one year of medical claims processing experience is preferred