Claim Adjustment & Recoupment II

Medica•Minnetonka, MN

1d•Hybrid

About The Position

Medica is a nonprofit health plan serving over a million members across multiple states. We are committed to providing personalized healthcare experiences and collaborating with providers to ensure our members receive excellent care. Our team values accountability, data-driven decisions, continuous learning, and collaboration. The Claim Adjustment & Recoupment II role is crucial for processing and reconciling claim-related overpayment recoveries. This involves handling returned checks, researching issues, and posting transactions to ensure financial accuracy and claim integrity. The ideal candidate will be detail-oriented, organized, and capable of managing a high volume of work in a collaborative environment.

Requirements

High school diploma or equivalent
2+ years of related administrative, claims, financial, operations, or related experience
Strong attention to detail and commitment to accuracy
Ability to manage a high-volume workload and meet daily productivity expectations
Strong organizational and time management skills
Proficiency with Microsoft Office applications
Ability to work independently while contributing to a collaborative team environment
Strong written and verbal communication skills
Must be legally authorized to work in the United States at the time of application.
Eligibility to work in the US: Medica does not offer work visa sponsorship for this role.

Nice To Haves

Experience working with health insurance claims or claim operations
HealthRules experience strongly preferred
SharePoint experience
Experience handling financial transactions, cash handling, payment processing, or reconciliation activities
Experience in healthcare, insurance, banking, accounting, or related operational environments
Familiarity with claim adjustment, overpayment recovery, or recoupment processes

Responsibilities

Process and reconcile claim overpayment recoveries, including receiving, reviewing, and posting returned checks.
Research and resolve issues related to claim adjustments, recoupments, and payment discrepancies.
Manage daily inventory of assigned work and meet productivity expectations while maintaining accuracy.
Handle physical checks and ensure appropriate controls are followed for large dollar amounts.
Utilize internal systems and established procedures to investigate and resolve claim-related issues.
Work collaboratively within a shared team environment, including management of a shared email inbox.
Maintain organized workflows and support inventory turnaround goals.
Partner with Finance and other internal stakeholders as needed to resolve payment and recoupment issues.
Follow departmental policies, procedures, and standard operating processes to ensure compliance and consistency.
Assist with bad address research and other administrative processes related to claim recoveries.
Perform other duties as assigned.