Claim Appeals & Correspondence II

Medica•,

7d•$37,600 - $56,385•Remote

About The Position

The Claim Appeals & Correspondence II position manages assigned inventory involving claim appeals, customer service concerns, internal inquiries, and escalated VIP issues. This intermediate-level role supports post-adjudication claims operations by researching, analyzing, and resolving claim-processing issues with limited supervision. The position collaborates with cross-functional partners to resolve claim decisions and questions and support accurate, timely outcomes. Other duties may be assigned. This is a remote position. Candidates must have a primary home address in a 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, or WI. Medica does not offer work visa sponsorship. Applicants must be legally authorized to work in the United States at the time of application, and employment is contingent on verification of identity and work eligibility. The full salary grade is $37,600–$64,400, with a typical hiring range of $37,600–$56,385. Annual salary placement may depend on education, work experience, applicable certifications or licensure, role scope and responsibility, internal pay equity, and external market salary data. Medica describes its total rewards package as including competitive medical, dental, and vision benefits, PTO, holidays, paid volunteer time off, 401(k) contributions, caregiver services, and other benefits. Compensation and benefits are subject to change.

Requirements

High school diploma or equivalent.
Two years of related work experience.
Strong analytical and problem-solving skills, including the ability to research and resolve moderately complex issues.
Ability to work independently with limited supervision.
Basic proficiency in Microsoft Excel, including sorting, filtering, and working with spreadsheets.
Strong verbal and written communication skills.
Strong customer-service and relationship-building skills.
Ability to manage multiple priorities and assigned inventory in a fast-paced environment.
Strong attention to detail and accuracy.
Ability to collaborate effectively across departments.
Legally authorized to work in the United States at the time of application; Medica does not offer work visa sponsorship.
Primary home address must be in a 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, or WI.

Nice To Haves

Experience in health insurance, healthcare administration, or claims operations.
Experience researching, adjusting, or reprocessing medical claims.
Knowledge of Medicare and Medicaid programs.
Understanding of Coordination of Benefits (COB).
Experience managing high-volume inventories, queues, work baskets, or case-management systems.
Knowledge of commercial and government healthcare claims.
Experience working collaboratively across claims-related operational functions.

Responsibilities

Manage daily inventory of claim appeals, customer service issues, internal inquiries, and escalated VIP cases.
Research, analyze, and resolve claim-processing issues and questions.
Review claims to identify processing discrepancies and determine appropriate next steps.
Manage assigned reports, work baskets, correspondence, email assignments, and special projects through completion.
Collaborate with PNOM, 1st Pass Claims, PI, Coding, Configuration, and other departments as needed to resolve claim decisions and questions.
Independently manage moderately complex administrative responsibilities with limited supervision.
Provide timely responses and updates regarding open claims, inquiries, and escalated cases.
Maintain effective working relationships with internal business partners.
Meet established quality, productivity, and inventory-management expectations.
Support process-improvement efforts that promote claims accuracy and operational efficiency.
Perform other duties as assigned.