Claims Representative

Sanford Health

Claims Representative processing health insurance claims for Sanford Health. Requiring strong understanding of claims processing and relevant documentation.

Posted 5/22/2026full-timeRemote • Wisconsin • 🇺🇸 United StatesJuniorMid-Level💰 $16 - $26 per hourWebsite

About the role

Key responsibilities & impact

Responsible for processing health insurance claims submitted via paper or electronically by providers and members.
Proficient understanding of Tapestry functionality.
Proficient knowledge to releases health insurance claims for payment, understands claims codes according to the defined workflows.
Proficient in the processing of claim adjustments based on appeals, configuration and/or benefit change.
Basic knowledge of coordination of benefit functions and rules, a basic understanding of third party liability, subrogation and third party processing.
Evaluates claims that need additional information prior to processing.
Determines proper benefit levels that apply to claims per the certificate of insurance and/or the summary of plan documents.
Understands the specific product lines.
Understands accumulators for accurate monitoring of maximum out of pocket expenses for claims processing.
Mentoring of teammates through peer-to-peer conversations.
Processes large quantities of detailed information with high levels of accuracy.
Investigates beneath the surface of an issue to focus systematically on root causes; communicates findings with the Senior Claims Representative.

Requirements

What you’ll need

High school diploma or equivalent required.
Associate degree preferred.
Two years of applicable experience required.
Two years of medical claims processing experience is preferred.
Knowledge of benefits, summary plan documents, certificates of insurance, and explanation of benefits.

Benefits

Comp & perks

🌐 Worldwide ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs ✉️ Email Alerts 👤 Account Sanford Health Website LinkedIn All Job Openings 10,000+ employees Founded 1894 ⚕️ Healthcare Insurance Healthcare Insurance Sanford Health is the largest rural health system in the United States, dedicated to transforming the healthcare experience and providing access to world-class healthcare in America's heartland. Headquartered in Sioux Falls, South Dakota, Sanford Health serves over 1. 4 million patients and nearly 200,000 health plan members across 250,000 square miles. The integrated health system includes 48 medical centers, 211 clinic locations, and more than 160 senior living centers, employing 2,900 physicians and advanced practice providers. Sanford Health is committed to offering compassionate care through its Centers of Excellence, focusing on specialties such as cancer, orthopedics, women’s health, and genetics. Additionally, it provides affordable health insurance, engages in extensive clinical trials, and supports personalized genetic medicine. Claims Representative Job not on LinkedIn 🔥 2 minutes ago 🧀 Wisconsin – Remote 💵 $16 - $25 / hour ⏰ Full Time 🟢 Junior 🟡 Mid-level 📋 Claims Specialist 🚫👨‍🎓 No degree required 🦅 H1B Visa Sponsor Apply Now Find Hiring Managers Customize resume + cover letter Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 Description
Responsible for processing health insurance claims submitted via paper or electronically by providers and members.
Proficient understanding of Tapestry functionality.
Proficient knowledge to releases health insurance claims for payment, understands claims codes according to the defined workflows.
Proficient in the processing of claim adjustments based on appeals, configuration and/or benefit change.
Basic knowledge of coordination of benefit functions and rules, a basic understanding of third party liability, subrogation and third party processing.
Evaluates claims that need additional information prior to processing.
Determines proper benefit levels that apply to claims per the certificate of insurance and/or the summary of plan documents.
Understands the specific product lines.
Understands accumulators for accurate monitoring of maximum out of pocket expenses for claims processing.
Mentoring of teammates through peer-to-peer conversations.
Processes large quantities of detailed information with high levels of accuracy.
Investigates beneath the surface of an issue to focus systematically on root causes; communicates findings with the Senior Claims Representative. 🎯 Requirements
High school diploma or equivalent required.
Associate degree preferred.
Two years of applicable experience required.
Two years of medical claims processing experience is preferred.
Knowledge of benefits, summary plan documents, certificates of insurance, and explanation of benefits. Apply Now 📊 Check your resume score for this job Improve your chances of getting an interview by checking your resume score before you apply. Check Resume Score Similar Jobs Revenue Cycle Associate II 🔥 8 hours ago Exact Sciences 5001 - 10000 ⚕️ Healthcare Insurance 🧬 Biotechnology 🔬 Science Website LinkedIn All Job Openings Revenue Cycle Coverage and Claims Associate responsible for filing insurance claims and ensuring reimbursement details. Utilizing Epic and other software to support coverage verification and claims management. 🇺🇸 United States – Remote 💵 $41.2k - $61.8k / year ⏰ Full Time 🟢 Junior 🟡 Mid-level 📋 Claims Specialist 🚫👨‍🎓 No degree required 🦅 H1B Visa Sponsor Revenue Cycle Associate I 🔥 8 hours ago Exact Sciences 5001 - 10000 ⚕️ Healthcare Insurance 🧬 Biotechnology 🔬 Science Website LinkedIn All Job Openings Revenue Cycle Coverage and Claims Associate filing insurance claims for Exact Sciences. Ensure eligibility verification and proper documentation in a team-oriented environment. 🇺🇸 United States – Remote 💵 $36.8k - $55.2k / year ⏰ Full Time 🟢 Junior 🟡 Mid-level 📋 Claims Specialist 🚫👨‍🎓 No degree required 🦅 H1B Visa Sponsor Inside Auto Claims Adjuster 🔥 13 hours ago Allstate 10,000+ employees 💸 Finance Website LinkedIn All Job Openings Inside Auto Claims Adjuster investigating and negotiating auto insurance claims. Collaborating with claimants and internal teams to ensure customer-focused resolutions in the United States. 🇺🇸 United States – Remote 💵 $50k - $60k / year 💰 Post-IPO Equity on 2014-01 ⏰ Full Time 🟢 Junior 🟡 Mid-level 📋 Claims Specialist 🚫👨‍🎓 No degree required 🦅 H1B Visa Sponsor Workers Compensation Claims Examiner 🔥 17 hours ago Sedgwick 10,000+ employees 🏢 Enterprise 📋 Compliance Website LinkedIn All Job Openings Workers' Compensation Claims Examiner handling and resolving claims in New York jurisdiction. Join Sedgwick, a leader in risk and claims administration, offering a caring culture and growth opportunities. 🇺🇸 United States – Remote 💵 $80k - $90k / year ⏰ Full Time 🟢 Junior 🟡 Mid-level 📋 Claims Specialist 🚫👨‍🎓 No degree required 🦅 H1B Visa Sponsor Workers’ Compensation Claims Adjuster 🔥 17 hours ago MDD Forensic Accountants 201 - 500 💸 Finance Website LinkedIn All Job Openings Workers’ Compensation Claims Adjuster managing Florida claims. Investigating, evaluating, and ensuring compliance with Florida statutes while delivering exceptional service. 🇺🇸 United States – Remote 💵 $65k - $70k / year ⏰ Full Time 🟡 Mid-level 🟠 Senior 📋 Claims Specialist View More Claims Specialist Jobs 🌐 Worldwide Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com Search Search Jobs by country Search jobs by city Search jobs by job title Search entry-level jobs Search junior-level jobs Search senior-level jobs Search jobs by tech stack Search jobs by contract type Search remote internships Search remote part-time jobs Remote jobs Anywhere in the World Companies Hiring Anywhere in the World Companies Hiring Sales People Anywhere in the World Companies Hiring Software Engineers Anywhere in the World Resources Advice Tips for finding remote jobs Interview questions and answers Resume examples Cover letter examples Post a job Affiliates Privacy policy Terms of service Job board SEO course AI Apply Copilot OpenClaw job finder Jobs by Country Remote jobs anywhere in the world (Worldwide remote jobs) Remote jobs United States Remote jobs Australia Remote jobs Brazil Remote jobs Canada Remote jobs France Remote jobs Ireland Remote jobs Germany Remote jobs Netherlands Remote jobs Spain Remote jobs UK Popular Jobs Remote data analyst jobs Remote customer support jobs Remote executive assistant jobs Remote marketing jobs Remote product designer jobs Remote product manager jobs Remote project manager jobs Remote recruiter jobs Remote sales jobs Remote software engineer jobs Jobs by Type Remote full-time jobs Remote part-time jobs Remote contract jobs Remote internship jobs Remote entry-level jobs Remote jobs with no experience required Remote junior jobs (1-3 years of experience) Digital nomad jobs Remote jobs with no degree required Freelance remote jobs Temporary remote jobs Remote jobs hiring now Stay at home mom jobs

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

health insurance claims processingTapestry functionalityclaims codesclaim adjustmentscoordination of benefitsthird party liabilitysubrogationbenefit levelsaccumulatorsmedical claims processing

Soft Skills

mentoringcommunicationattention to detailanalytical thinkingproblem-solving

Certifications

high school diplomaassociate degree