Claim Adjustment & Recoupment II

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.

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.

Key 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

Required Qualifications

• High school diploma or equivalent
• 2+ years of related administrative, claims, financial, operations, or related experience

Preferred Qualifications

• 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

Skills and Abilities:

• 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

This position is an Office role, which requires an employee to work onsite at our Minnetonka, MN office, on average, 3 days per week.

The full salary grade for this position is $37,600 - $64,400. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $37,600 - $56,385. 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.