Claim Accumulator II

Medica•,

7d•$41,300 - $61,950•Remote

About The Position

Medica's Claim Accumulator II is responsible for maintaining and updating member accumulators by working daily inventory reports and processing changes related to benefit plans, membership updates, system errors, and other product requirements. This role requires knowledge of both medical and pharmacy claims processing and works closely with internal stakeholders and external vendors to ensure accumulator accuracy and operational effectiveness. Performs other duties as assigned.

Requirements

High school diploma or equivalent
2+ years of related work experience

Nice To Haves

Experience working in a healthcare, insurance, claims, or operations environment
Knowledge of medical and pharmacy claims processing
Experience working with accumulator processes and reporting
Familiarity with health insurance products and benefit administration
Experience working with vendor partners such as Optum or ESI

Responsibilities

Review and process daily accumulator inventory reports to ensure timely and accurate completion
Validate report data and investigate discrepancies, errors, or missing information
Update accumulators based on plan changes, subscription changes, product requirements, and system corrections
Research and resolve accumulator-related issues involving medical and pharmacy claims
Submit and track system tickets for identified errors and communicate issues to leadership and IT teams
Monitor and communicate report and inventory status, progress, and risks to leadership
Participate in meetings with internal business partners, operational teams, and vendor partners
Collaborate with senior accumulator team members, Scrum Masters, IT, and business stakeholders on system enhancements and process improvements
Support vendor relationships and issue resolution activities involving Optum and ESI
Maintain documentation and ensure compliance with organizational policies and procedures