Claim Appeals & Correspondence I

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

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.

Key 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

Required Qualifications

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

Preferred Qualifications

• 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

This position is a Remote role.To be eligible for consideration, candidates must have a primary home address located within any state where Medica is registered as an employer - AR, AZ, FL, GA, IA, IL, KS, KY, MI, MN, MO, ND, NE, OK, SD, TN, TX, VA, WI

The full salary grade for this position is $34,200 - $58,600. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $34,200 - $51,240. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

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.

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.