[Hiring] Claims Appeals & Correspondence I @Medica

Role Description

The Claims Appeals & Correspondence I position supports post-adjudication claims operations by managing appeals, claim inquiries, customer service concerns, and escalated issues. This role researches, analyzes, and resolves claim processing issues while working closely with internal teams to ensure accurate claim outcomes and timely resolution of member and provider requests. Performs other duties as assigned.

• 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

Qualifications

• High school diploma or equivalent
• One year of related work experience

Requirements

• Experience in health insurance, healthcare administration, or claims operations
• Knowledge of Medicare, Medicaid, and commercial health insurance claims
• Experience researching, adjusting, or reprocessing medical claims
• Understanding of Coordination of Benefits (COB)
• Experience managing high-volume workloads, queues, or case management systems

Skills and Abilities

• Basic Microsoft Excel skills, including sorting, filtering, and working with spreadsheets
• Strong written and verbal communication skills
• Excellent customer service skills
• Strong attention to detail and problem-solving abilities
• Ability to manage multiple priorities in a fast-paced environment
• Ability to work independently and collaboratively across teams

Benefits

• Competitive medical, dental, and vision plans
• PTO and Holidays
• Paid volunteer time off
• 401K contributions
• Caregiver services
• Generous total rewards package

Eligibility to work in the US

Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

Equal Opportunity Employer

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.