All about us
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.
Work environment
This opportunity is eligible for a remote, hybrid, or in-office work 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 and external applications.
Pay Information
Pay Level: 017
FLSA Category: Non-Exempt - Hourly
A day in the life
The Appeals Case Owner is responsible for the management of reviewing, researching, and resolving grievances, appeals, complaints and disagreements by members and providers. This role ensures resolutions are consistent with department, regulatory, and accreditation guidelines, and are handled timely and efficiently. This position works closely with clinical, coding and reimbursement, claims, customer contact center, and other areas as needed to ensure resolution of requests.
Your responsibilities will include
- Reviews emergent and standard appeal requests and makes appropriate determination of steps required to complete the appeal using knowledge, judgement, expertise, and standards of practice according to applicable appeal procedures.
- Ensures claims are reprocessed following appeal determinations and adjusted with high accuracy.
- Monitors multiple appeal timelines to ensure all required standards are met.
- Creates and sends appropriate appeals letters to members, providers, or other authorized appellants.
- Ensures proper follow up with member, provider, or authorized appellant to gather additional information.
- Interacts with various areas/individuals of the organization to research and solve pending appeals and provides back-up support for affiliate department tasks.
- Participates in departmental and corporate initiatives by participating in improvement committees that assess current processes for procedural and efficiency improvements.
- Participates in a rotating on-call schedule for holidays and weekends.
- Identifies patterns through appeals received for potential provider education opportunities as well as internal education to various areas.
- Works closely with the liaison for North Dakota Insurance Department as well as directly with the North Dakota Insurance Department on specific types of requests.
- Collaborates with various vendors initiating communications and submitting on-line appeals through their portals.
What you need to succeed
- High School Diploma/GED with 3 years of claims and/or call center experience.
- Appeals experience a plus!
- A good level of accuracy and attention to the details.
- Strong written communication skills with the ability to collaborate with other team members.
- Ability to prioritize work, follow timelines and reprioritize as needed.
- Enjoys a fast-paced work environment.
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 and perks
- Wellness incentives including well-being lifestyle spending accounts, employee assistance program and employee discounts.
- Encouraged paid time off including paid holidays and flexible holidays to use as you wish.
- 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.
- Our core benefits include health, dental, vision and life insurance, short-term and long-term disability and paid parental leave.
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 9/20/2024 at 12:00 p.m. (CT). No further applications will be considered.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)
