Remote Claims Appeals & Correspondence Specialist

Medica; Minnetonka (MN); Remote; USD 34,000 - 59,000; Full time

Job summary

Medica is a nonprofit health plan serving a broad member base in multiple states. The Claims Appeals & Correspondence I role supports post-adjudication operations by managing appeals, inquiries, and escalated issues, researching and resolving claim processing problems to ensure accurate outcomes.

The position is remote and requires attention to detail, effective communication, and collaboration with cross-functional teams to maintain timely resolutions and service standards.

Qualifications

• High school diploma or equivalent.
• One year of related work experience.
• Experience in health insurance, claims operations, or Medicare/Medicaid preferred.
• Knowledge of Coordination of Benefits (COB) is a plus.
• Experience managing high-volume workloads, queues, or case management systems.

Responsibilities

• Manage assigned inventory of claim appeals, inquiries, correspondence, and operational requests.
• Research, analyze, and resolve claim processing and payment issues, including claim reprocessing when needed.
• Review paid claims and investigate payment discrepancies or date-of-service concerns.
• Respond to incoming mail, correspondence, and inquiries within established service standards.
• Collaborate with cross-functional teams to resolve claim questions and support claim accuracy.
• Manage escalated and high-priority claim issues.
• Maintain work queues, email assignments, and case inventory while meeting quality and productivity expectations.
• Provide inventory updates and status reporting as needed.
• Support process improvement initiatives that enhance claims accuracy and operational efficiency.

Skills

Excel

Communication

Customer service

Attention to detail

Multitasking

Cross-team collaboration

Education

High school diploma

Job description

Medica is a nonprofit health plan serving a broad member base in multiple states. The Claims Appeals & Correspondence I role supports post-adjudication operations by managing appeals, inquiries, and escalated issues, researching and resolving claim processing problems to ensure accurate outcomes.

The position is remote and requires attention to detail, effective communication, and collaboration with cross-functional teams to maintain timely resolutions and service standards.