Claim Adjustment & Recoupment II
About The Position
Medica's Claim Adjustment & Recoupment II role is responsible for processing and reconciling claim-related overpayment recoveries, including receiving, researching, and posting returned checks. This position plays an important role in ensuring accurate financial transactions and maintaining claim integrity. The ideal candidate is highly detail-oriented, organized, and able to manage a high-volume workload while collaborating closely with team members and business partners. Responsibilities include working with live checks, conducting research and resolution activities, maintaining inventory timeliness, and supporting recoupment-related processes. Perform other duties as assigned.
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.
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
Benefits
- competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
