Remote Claims Appeals Analyst II

Medica Services Company LLC; Minnetonka (MN); Remote; USD 38,000 - 64,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Paid time off (PTO)

Holidays

401K contributions

Volunteer time off

Job summary

Medica Services Company LLC is seeking a remote Claims Appeals & Correspondence II to manage inventory of claim appeals and VIP cases, researching and resolving processing issues with limited supervision.

The role collaborates across departments to ensure timely outcomes, maintain quality, and support process improvements in post-adjudication operations. Strong analytical skills and Excel proficiency are required.

Qualifications

• High school diploma and 2 years of related work experience required.
• Experience in health insurance, healthcare administration, or claims operations preferred.

Responsibilities

• 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 next steps.
• Manage reports, work baskets, correspondence, email assignments, and special projects to completion.
• Collaborate with internal departments to resolve claim decisions and questions.
• Independently manage moderately complex administrative tasks with limited supervision.
• Provide timely responses and updates on open claims and escalations.
• Maintain relationships with internal partners and meet quality, productivity, and inventory targets.
• Support process improvements for claims accuracy and efficiency.

Skills

Analytical thinking

Independent work

Communication skills

Customer service

Multitasking

Attention to detail

Education

High school diploma or equivalent

Tools

Microsoft Excel

Job description

Medica Services Company LLC is seeking a remote Claims Appeals & Correspondence II to manage inventory of claim appeals and VIP cases, researching and resolving processing issues with limited supervision.

The role collaborates across departments to ensure timely outcomes, maintain quality, and support process improvements in post-adjudication operations. Strong analytical skills and Excel proficiency are required.