Claims Specialist - Contract Position in Fargo, ND

Overview

Join our Claims Operations team as a Claims Production Professional II on a 12-month contract based in Fargo, ND. This role involves precise processing of medical claims across various benefit plans, ensuring compliance with policy and regulatory standards while delivering excellent service to members and providers.

Key Responsibilities

• Accurately and efficiently adjudicate diverse claim types independently within initial 90 days, consistently meeting departmental benchmarks for quality, timeliness, and productivity.
• Handle claims investigations meticulously, interpret contract benefits correctly, resolve exceptions, and maintain thorough documentation supporting adjudications.
• Communicate clearly with members, providers, and internal partners to explain claims decisions and resolve issues professionally while upholding confidentiality.
• Process increasingly complex claims by applying critical thinking and benefit interpretation skills, escalating matters as necessary while retaining accountability.
• Contribute to operational excellence by identifying improvements in workflows, documentation, and system use, collaborating on projects that enhance claims processing efficiency.
• Support team goals by adapting to dynamic priorities, embracing learning opportunities, and providing constructive feedback to improve processes.
• Evaluate and responsibly implement AI and automation tools within 3 to 6 months to enhance documentation, workflow, quality reviews, and productivity without compromising accuracy or compliance.

Preferred Qualifications

• High school diploma or equivalent.
• About two years' office experience, preferably in health insurance claims processing, healthcare administration, or medical office environment.
• Proficiency with Microsoft Office applications including Word, Outlook, and Excel.
• Strong skills in data entry, keyboarding, analytics, and mathematics.
• Exceptional attention to detail with the ability to maintain consistent quality and productivity levels.
• Ability to quickly learn multiple claims processing systems and procedures.
• Capable of working independently while collaborating effectively within team settings.

Definition of Success

Within the first year, be recognized as a reliable Claims Production Professional who meets or surpasses quality and productivity objectives, handles various claim types with minimal supervision, delivers excellent member and provider service, adapts swiftly to shifting priorities, and actively supports continuous process improvements that enhance operational effectiveness.