Entry Level Claims Customer Service Representative

Only Apply if you live in the State of North Dakota. You must show proof you live in the State of North Dakota. Gain professional Entry level, paid training, work remote (you must live in the State of North Dakota. Work Monday through Friday 8:00 AM to 4:00 PM CST. We are seeking detail-oriented Claims Production Professionals to support accurate and timely medical claims processing. This role involves investigating, analyzing, and adjudicating claims while ensuring compliance with benefit contracts, company policies, and quality standards. The ideal candidate is analytical, adaptable, customer-focused, and able to balance productivity with accuracy in a fast-paced environment.

Key Responsibilities

• Review, investigate, and process medical claims accurately and within established turnaround times.
• Apply benefit contracts, eligibility rules, pricing, and coordination of benefits to ensure proper claim adjudication.
• Research, correct, and reprocess claims as needed while maintaining complete documentation and audit trails.
• Respond to member, provider, and internal inquiries regarding claims and benefit applications.
• Ensure compliance with policies, privacy requirements, quality standards, and regulatory guidelines.
• Identify process improvement opportunities and contribute to operational efficiency initiatives.
• Utilize AI and automation tools responsibly to enhance productivity, documentation, and workflow organization while maintaining compliance and accuracy.

Success Measures

• Meet or exceed quality, productivity, accuracy, and timeliness standards.
• Independently manage multiple claim types and increasingly complex claims.
• Deliver excellent customer service and effective issue resolution.
• Demonstrate sound judgment, adaptability, and continuous improvement contributions.

Preferred Qualifications

• High school diploma or equivalent.
• Approximately 2 years of office experience, preferably in health insurance, healthcare administration, or a medical office setting.
• Proficiency in Microsoft Office (Word, Outlook, Excel).
• Strong data entry, analytical, mathematical, and problem-solving skills.
• Exceptional attention to detail and ability to meet productivity goals.
• Ability to learn multiple systems and work independently while collaborating within a team.

Definition of Success
Within the first year, the successful candidate will consistently meet quality and productivity standards, accurately process a variety of claims with minimal supervision, provide excellent service to members and providers, adapt to changing priorities, and support continuous improvement efforts within Claims Operations.

Company: Confidential Health Insurance Company
Organization: Claims, Core Operations
Industry: Healthcare, Health Insurance, Medical Claims
Location: Fargo, North Dakota. Must reside in the state of North Dakota.
Work Arrangement: Hybrid – REMOTE: Monday through Friday
Employment Type: Contract - 12 Months
Reporting To: Claims Manager