Claims Specialist

• The position of Care Advocate will play a leading role in developing an innovative digital product strategy based off your deep expertise and knowledge of the long-term care needs of the aging in your market.
• You will be part of a team delivering concierge services care-seekers and care-managers including but not limited to Caregiver support and Education.
• Conducting consultations with older adults and caregivers on aging services and supports providing support and guidance on the caregiving journey.
• Unlike other traditional Care Advocacy roles, your responsibilities will not stop there but will extend to working with digital product teams to help infuse your patient-centered knowledge into the design process and provide feedback that will help create incredible digital user experiences for millions of care-seekers and care-managers at a tremendous scale.
• This role will provide Subject Matter expertise on the local and state level programming and resources for aging adults and their caregivers.
• This role will provide education and resources to aging individuals seeking assistance with care options and navigating challenges.
• Intensive case management experience and crisis intervention.
• Approach problem-solving with a human-centered lens.
• Regular document key and frequent needs of users and report qualitative data (such as quotes and anecdotal stories that representative of user needs) and quantitative data (such as frequency of user needs and trends in gaps in local care environments and resources) to the digital product and design teams.
• Bring deep understanding of landscape and individual aging and long-term resources, facilities, organizations, agencies, and referral sources to help marketing team reach key partnerships and potential consumers who would benefit from our digital products.
• Report back to product and design teams opportunities for improvement of the digital products based off of user feedback.
• Review new product features before they are released to consumers to identify improvements or potential issues to proactively improve user experience.

Associate Claims Clinical, Care Advocacy

• Completes field inspections and related responsibilities such as reading maps and aerial photos
• Measuring fields, storage bins, and discussing findings of crop loss with farmers on the most complex non-routine, problematic claims
• Conveys complex regulations and interpretations to claimants, agents, and industry people on claim situations
• Performs fact finding regarding crop damage, records information and transmits loss information to accurately determine potential indemnities
• Gathers relevant facts, utilizing applicable law and establishing basic principles of negligence
• Completes claim reviews and audits on lower-level adjusters as assigned
• Ensures legal compliance by maintaining a strong working knowledge of regulatory and company policies and procedures

Crop Claims Field Adjuster II

• 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
• Releases health insurance claims for payment according to the defined workflows
• Works assigned pend and error reports
• Determines benefit level to be paid according to the summary plan language
• Responds promptly to requests for information from other Sanford Health Plan departments
• Refers complex claims to Senior and/or Lead Claims Representatives.

Associate Claims Representative

• Investigate and resolve Homeowners claims of moderate complexity in a prompt and efficient manner.
• Document with photographs, measurements, recorded interviews as needed, write a repair estimate to capture damages, and complete thorough file notes.
• Ability to use imagery and advanced video technology to collaborate with onsite vendors and insureds to identify damage and write damage estimates from a virtual setting.
• Compare facts gathered during the investigation against the policy to determine coverage of claim; extend or deny coverage as appropriate.
• Establishes reserve amounts within prescribed settlement authority limit and negotiates settlement of claims; recommends claims which exceed personal authority limit to supervisor for approval.
• Responsible for effectively and timely communicating with insureds and /or their representatives to resolve issues and ensure customer satisfaction.

Claims Specialist jobs in South Dakota

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Associate Claims Clinical, Care Advocacy

Crop Claims Field Adjuster II

Associate Claims Representative

Property Claims Examiner II – Wind/Hail