Senior Claims Advocate (Medicaid Expansion)

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 open to a remote, hybrid or an 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. Pay information • Pay Level: 018 • 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 salary for this position is $20.32 - $27.00 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 Senior Claims Advocate is responsible for reviewing complex health insurance claims and inquiries and determining whether to return, deny, or pay claims following organizational policies and procedures. Your Responsibilities Will Include • Reviews claim inquiries by analyzing, interpreting, and researching the request to determine appropriate action. • Utilizes various systems and process guidelines to review, process, and adjudicate claims, ensuring quality and timeliness standards are met. • Initiates requests to update member information, when necessary. • Achieves and maintains a clear understanding of all systems, applications, and procedures necessary to identify denial codes, edits, and processing codes pertaining to all claims in order to process claims correctly. • Responds to incoming reports, medical records, and other related documents to make claim determinations for additional processing. • Performs research on claims history, contract benefits, or other relevant documentation to process outstanding claims and make determinations on how to move the claim through the process. • Performs work under minimal supervision. Handles complex issues and problems and refers more complex issues to higher-level staff. • Coaches and mentors department staff and collaborates with leadership to support strategic goals within the team. What You Need To Succeed • A high school diploma, or GED, is required • A minimum of 5 years of experience in claims processing, insurance, or related work • Demonstrates advanced attention to detail and accuracy • Maintains strong task and goal focus • Applies advanced problem-solving and resolution skills • Communicates effectively, both verbally and in writing • Adapts flexibly to changing priorities and environments • Builds effective interpersonal relationships and communicates well with others 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 and Health Savings Accounts. Voluntary employee contributions to Health Savings Accounts and Flexible Spending Accounts • 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. Equal opportunity employment Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law. For questions, please email [email protected]. Application Deadline: This posting is scheduled to close on 1/30/2026 at 8:00 a.m. (CT). However, it may be closed earlier if a high volume of qualified applications is received. We encourage interested candidates to apply promptly. This position is not eligible for employment-based visa sponsorship. Candidates must be legally authorized to work in the United States at the time of application and for the entire duration of employment without the need for sponsorship. Apply tot his job