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.