Remote Claims Appeals & Correspondence Specialist II

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

Benefits offered by this job

Medical, dental, vision benefits

Paid time off and holidays

401K contributions

Caregiver services

Disability and life insurance

Job summary

Medica, a nonprofit health plan, seeks a Claim Appeals & Correspondence II to manage inventory of claim appeals, VIP cases, and inquiries remotely from the United States. The role involves researching, analyzing, and resolving post-adjudication issues with cross-functional partners to ensure timely, accurate outcomes.

Ideal candidates have 2+ years in health insurance or claims operations, strong Excel and communication skills, and a keen eye for detail to meet quality and productivity targets.

Qualifications

• High school diploma or equivalent and 2 years related work experience required.
• Experience in health insurance, healthcare administration, or claims operations preferred.
• Knowledge of Medicare/Medicaid and Coordination of Benefits is a plus.

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, and email assignments
• Collaborate with PNOM, 1st Pass Claims, PI, Coding, Configuration, and other departments
• Independently manage moderately complex administrative responsibilities with limited supervision
• Provide timely responses and updates regarding open claims and escalated cases
• Maintain effective working relationships with internal partners
• Meet established quality, productivity, and inventory management expectations
• Support process improvements that promote claims accuracy and efficiency

Skills

Analytical skills

Independent work

Excel basics

Verbal and written communication

Customer service

Multi-tasking

Attention to detail

Cross-department collaboration

Education

High school diploma or equivalent

Tools

Microsoft Excel

Job description

Medica, a nonprofit health plan, seeks a Claim Appeals & Correspondence II to manage inventory of claim appeals, VIP cases, and inquiries remotely from the United States. The role involves researching, analyzing, and resolving post-adjudication issues with cross-functional partners to ensure timely, accurate outcomes.

Ideal candidates have 2+ years in health insurance or claims operations, strong Excel and communication skills, and a keen eye for detail to meet quality and productivity targets.