Claims Advocate

BCBSND - Fargo 4510 13th Ave South Fargo, ND 58121, USA

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

• 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 Advocate is responsible for reviewing moderately 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 the 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 for accurate claim processing.
• Responds to incoming reports, medical records, and 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 determine how to move the claim through the process.
• Performs work under general supervision; handles moderately complex issues and problems and refers more complex issues to higher‑level staff.

What you need to succeed

• A High School Diploma/GED along with 3 years of experience in claims processing, data entry, insurance, or related experience.

Demonstrates consistent accuracy when reviewing information, identifying discrepancies, and completing tasks. Ensures work is thorough, error‑free, and aligned with established standards and procedures.

• Stays organized, meets deadlines, and follows through on commitments with minimal oversight.

Communicates clearly and professionally in both verbal and written formats.

Tailors messages to the audience, asks clarifying questions when needed, and documents information accurately to support efficient workflow and collaboration.

Adjusts effectively to changes in priorities, processes, or workload demands.

Remains productive and positive in dynamic…