Claims Service Advocate (FEP)

About the position You likely know us as an insurance company, but that’s just a portion of what we do. Hundreds of thousands of North Dakotans trust us to provide them with personalized service and unmatched access to care. It’s a mission we take seriously. We also work with entities throughout the state to challenge the cost and complexity of health care in North Dakota. This uncompromising goal requires caring, innovative people who are ready and willing to help create a new level of health and well-being in North Dakota and beyond. Our Strategic Affiliation with Cambia In 2026, BCBSND and Cambia Health Solutions formed a strategic affiliation to enhance access to simpler, more affordable health care while keeping a strong local focus. The affiliation was approved by North Dakota regulators and became effective Feb. 1, 2026. Under this affiliation, BCBSND employees became Cambia employees while continuing to serve the BCBSND market. Day‑to‑day work and hiring continue as usual. Work environment This opportunity is open to a remote, hybrid or in-office working arrangement. We empower our employees to find a work style that is best for them. Learn more at Life at Blue | BCBSND . This position is eligible for internal Blue Cross Blue Shield employees and external applications. Pay information Pay Level: 017 FLSA Category: Nonexempt – Hourly Individual pay will be based on skills, experience, qualifications, location, internal equity, and other relevant factors. Opportunities for continued salary growth through a performance-based merit program. The estimated starting pay for this position is $18.70 - $25.00. At BCBSND, we’re committed to providing fair and equitable compensation. While the posted salary range reflects the full compensation range for this role, offers typically fall at or below the midpoint, and in alignment with internal equity and role expectations. Individual offers are based upon candidates’ unique experience, education, and skillsets. The top of the range reflects the ceiling for this role and is only used for offers in exceptionally rare cases. We do not extend offers above the posted maximum. A day in the life The Claims Service Advocate is responsible for reviewing moderately complex health insurance claims and provides customer service to members, providers, and/or customers by telephone, computers, and/or written inquiry. This position determines how to apply benefits and whether to return, deny, or pay claims following organizational policies and procedures.

Responsibilities

• Utilizes various systems and process guidelines to review, process, and adjudicate moderately complex claims, ensuring quality, accuracy, and timeliness standards are met.
• Reviews moderately complex claim inquires by analyzing, interpreting, and researching the request to determine appropriate action.
• Initiates any requests to update member information when necessary.
• Responds to incoming reports, medical records, and other related documents to make claim determinations for additional processing.
• Provides information, guidance, and education to members and customers in complex and escalated situations while working in close partnership with other internal departments to ensure customer satisfaction.
• Conducts research on behalf of members, providers, and customers, which may include the review of documents, statements, and information supplied by other outside agencies.
• Handles incoming and outgoing customer service calls in a clear and concise manner.
• Performs work under general supervision.
• Handles moderately complex issues and refers more complex issues to higher-level staff.

Requirements

• A High School Diploma/GED along with 3 years of experience in customer service, claims processing or related experience.
• Be a problem solver with the ability to research, analyze and define methods, practices, and procedures to resolve issues.
• Ability to communicate clearly and professionally in both verbal and written formats.
• Ability to work effectively with others, valuing diverse perspectives and fostering teamwork.
• Brings a creative mindset and a go-get-em’ attitude to find ways to improve upon processes and projects.
• A strong ability to prioritize and organize work with varying timelines for projects and daily work.
• Equivalent combination of education, experience or training determined to be acceptable by Human Resources may be substituted, unless regulated by contract or program standards

Benefits

• Affordable medical, dental and vision coverage accepted throughout the United States
• Employer funded Lifestyle Spending Accounts, Health Savings Accounts and Health Reimbursement Arrangements
• Employer-paid life and disability insurance
• 401(k) retirement plan with company match and immediate vesting
• Paid holidays, paid time off (PTO), PTO donation program, and paid parental leave
• Voluntary benefits including Accident, Hospital Indemnity, Critical Illness, Term/Whole Life, Cancer Care Insurance, and more.
• Additional company perks
• Robust mental health offerings including an Employee Assistance Program, Learn to Live, meQ.
• Comprehensive learning and development opportunities and an Educational Assistance Program.
• 16 hours of paid volunteer time with a $200 donation to a charity of your choice upon completion of all volunteer hours.
• Employee recognition, community initiative events and yearly company outings.
• Workplace flexibility offering different options for working arrangements and the freedom to make time for important commitments.
• Opportunities to connect through employee committees.

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