Claim Accumulator 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 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.

Key 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

Required Qualifications

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

Preferred Qualifications

• 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

Skills and Abilities

• Understanding of health insurance concepts, benefits, and claims administration
• Knowledge of accumulator operations and related processes
• Working knowledge of ESI systems or comparable claims platforms
• Basic Microsoft Excel skills, including data review and reporting
• Strong attention to detail and analytical problem-solving skills
• Effective verbal and written communication skills
• Ability to manage multiple priorities and meet deadlines
• Ability to work independently and collaboratively in a team environment

This position is a Remote role. To be eligible for consideration, candidates must have a primary home address located within any 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, WI

The full salary grade for this position is $41,300 - $70,800. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $41,300 - $61,950. 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.

Originally posted on Himalayas