Remote Claim Appeals & Correspondence II

Medica; United States; Remote; USD 38.000 - 64.000; Vollzeit

Zusammenfassung

Medica is a nonprofit health plan seeking a remote Claims Appeals & Correspondence II specialist. You will manage inventory of claim appeals, research and resolve processing issues, and collaborate with multiple departments to ensure accurate outcomes.

The role requires a high school diploma and 2 years of related work experience. Ideal candidates have health insurance/claims ops exposure and strong analytical, communication, and organizational skills.

Qualifikationen

• High school diploma or equivalent.
• 2 years of related work experience.

Aufgaben

• Manage daily inventory of claim appeals, customer service issues, internal inquiries, and escalated VIP cases.
• Research, analyze, and resolve claim processing issues and questions.
• Review claims to identify processing discrepancies and determine appropriate next steps.
• Manage assigned reports, work baskets, correspondence, email assignments, and special projects through completion.
• Collaborate with PNOM, 1st Pass Claims, PI, Coding, Configuration, and other departments as needed to resolve claim decisions and questions.
• Independently manage moderately complex administrative responsibilities with limited supervision.
• Provide timely responses and updates regarding open claims, inquiries, and escalated cases.
• Maintain effective working relationships with internal business partners.
• Meet established quality, productivity, and inventory management expectations.
• Support process improvement efforts that promote claims accuracy and operational efficiency.

Kenntnisse

Analytical skills

Independent work

Excel basics

Communication

Customer service

Multitasking

Attention to detail

Collaboration

Ausbildung

High school diploma or equivalent

Jobbeschreibung

Medica is a nonprofit health plan seeking a remote Claims Appeals & Correspondence II specialist. You will manage inventory of claim appeals, research and resolve processing issues, and collaborate with multiple departments to ensure accurate outcomes.

The role requires a high school diploma and 2 years of related work experience. Ideal candidates have health insurance/claims ops exposure and strong analytical, communication, and organizational skills.