Claims Processing Specialist

1 week ago

Madison, Wisconsin, United States Medica Full time

The Claims Adjustment & Recoupment I position at Medica plays a crucial role in the financial operations of the organization. This role involves meticulous analysis, reconciliation, and application of payments, as well as the processing and management of applications and correspondence. The individual will also oversee customer/member mailings, ensuring that all activities comply with regulatory, HIPAA, and service standards.

Primary Responsibilities:

  • Handle a variety of cash receipts, including lockboxes, ACH, card payments, cash, and Check Free payments.
  • Monitor and address held checks, ensuring proper investigation and allocation to the correct accounts.
  • Conduct bank account reconciliations by identifying and resolving payment discrepancies.
  • Prepare and input data from scanned documents accurately.
  • Analyze, update, and maintain departmental databases effectively.
  • Coordinate and manage the mailing of external documents efficiently.
  • Verify control totals and release files as necessary.
  • Maintain stringent departmental cash controls.
  • Engage with internal and external customers to resolve any issues that arise.

Qualifications:

  • High School diploma or equivalent is required.
  • A minimum of 1 year of relevant work experience is preferred.

Skills and Competencies:

  • Strong time management abilities.
  • Familiarity with health insurance processes is advantageous.
  • Proficient in Microsoft Office, with a particular emphasis on Excel skills.
  • Excellent verbal and written communication skills.
  • High attention to detail and a strong customer service orientation.
  • Robust organizational skills.
  • This is an office-based role that requires onsite presence.

Medica is committed to offering a competitive salary and benefits package, while fostering a culture of diversity, equity, and inclusion. We are an Equal Opportunity/Affirmative Action employer.

  • Property Field Inspection Claim Specialist

    5 days ago

    Madison, Wisconsin, United States State Farm Mutual Automobile Insurance Company Full time

    About the RoleWe are seeking a highly skilled Property Field Inspection Claim Specialist to join our team at State Farm Mutual Automobile Insurance Company. As a key member of our claims handling team, you will be responsible for handling accidental and weather-related claims for homeowners, commercial properties, and large losses.Key ResponsibilitiesConduct...

  • Property Field Inspection Claim Specialist

    1 week ago

    Madison, Wisconsin, United States State Farm Mutual Automobile Insurance Company Full time

    Job SummaryWe are seeking a highly skilled Property Field Inspection Claim Specialist to join our team at State Farm Mutual Automobile Insurance Company. As a key member of our claims handling team, you will be responsible for handling accidental and weather-related claims for homeowners, commercial properties, and large losses.Key ResponsibilitiesConduct...

  • Property Field Inspection Claim Specialist

    4 days ago

    Madison, Wisconsin, United States State Farm Mutual Automobile Insurance Company Full time

    About the RoleWe are seeking a highly skilled Property Field Inspection Claim Specialist to join our team at State Farm Mutual Automobile Insurance Company. As a key member of our claims handling team, you will be responsible for handling accidental and weather-related claims for homeowners, commercial properties, and large losses.Key ResponsibilitiesConduct...

  • Property Field Inspection Claim Specialist

    4 days ago

    Madison, Wisconsin, United States State Farm Mutual Automobile Insurance Company Full time

    About the RoleWe are seeking a highly skilled Property Field Inspection Claim Specialist to join our team at State Farm Mutual Automobile Insurance Company. As a key member of our claims handling team, you will be responsible for handling accidental and weather-related claims for homeowners, commercial properties, and large losses.Key ResponsibilitiesConduct...

  • Pharmacy Order Processing Specialist

    2 weeks ago

    Madison, Wisconsin, United States BrightSpring Health Services Full time

    PHARMACY ORDER PROCESSING SPECIALIST Job Locations:ID:Line of Business: BrightSpring Health ServicesPosition Type: Full-TimeAt BrightSpring Health Services, we are dedicated to providing exceptional pharmacy services tailored to the needs of our clients. With a strong focus on quality and service excellence, we have established ourselves as a leader in the...

  • Claims Management Specialist

    2 weeks ago

    Madison, Wisconsin, United States University of Wisconsin Full time

    POSITION OVERVIEWThe University of Wisconsin is a distinguished public higher education system, educating approximately 162,000 students annually and employing around 35,000 faculty and staff statewide.The Office of Risk Management is dedicated to fostering a safe and healthy educational environment for all individuals involved in UW System programs and...

  • Claims Management Specialist

    1 week ago

    Madison, Wisconsin, United States Universities of Wisconsin Full time

    About the OrganizationThe Universities of Wisconsin represent a distinguished system of public higher education, serving approximately 162,000 students annually and employing around 35,000 faculty and staff throughout the state.With a network of 13 universities, the Universities of Wisconsin stand as a vital academic, cultural, and economic asset for the...

  • Claims Resolution Specialist

    6 days ago

    Madison, Wisconsin, United States HomeSafe Alliance Full time

    About the RoleThe Assistant Claims Manager role is a remote opportunity responsible for ensuring the claim settlements meet or exceed customer expectations and comply with regulatory and company standards.**Key Responsibilities:**Manage large claims, catastrophic loss situations, mold, unusual occurrences, inconvenience claims, property damage claims, and...

  • Compensation Claims Specialist

    2 weeks ago

    Madison, Wisconsin, United States University of Wisconsin Full time

    POSITION OVERVIEWThe University of Wisconsin system is a distinguished network of public higher education institutions, educating approximately 162,000 students annually and employing around 35,000 faculty and staff statewide.The Office of Risk Management is dedicated to fostering a safe and healthy educational environment for all stakeholders involved in UW...

  • Claim Adjuster

    1 day ago

    Madison, Wisconsin, United States Medica Full time

    Job Summary:Medica is seeking a highly skilled and detail-oriented Claim Adjustment professional to join our team. As a Claim Adjustment, you will play a critical role in ensuring the accuracy and efficiency of our claims processing operations.Key Responsibilities:Process and analyze various types of medical claims, including inpatient and outpatient...

  • Compensation Claims Specialist

    1 week ago

    Madison, Wisconsin, United States University of Wisconsin Full time

    POSITION OVERVIEWThe University of Wisconsin system is a distinguished network of public higher education institutions, serving approximately 162,000 students annually and employing around 35,000 faculty and staff across the state.The Office of Risk Management is dedicated to fostering a safe and healthy educational environment for all individuals involved...

  • Senior Claims Investigator

    5 days ago

    Madison, Wisconsin, United States American Family Insurance Full time

    Job SummaryThis is a senior-level role that involves investigating and managing complex property and casualty claims. The successful candidate will be responsible for determining liability, securing information, reviewing coverages, arranging appraisals, and settling third-party property liability claims.Key ResponsibilitiesInvestigate Claims: Conduct...

  • Pharmacy Order Processing Specialist

    2 weeks ago

    Madison, Wisconsin, United States BrightSpring Health Services Full time

    Company OverviewBrightSpring Health ServicesPosition SummaryBrightSpring Health Services is a leader in providing specialized pharmacy solutions within the hospice sector. With decades of experience, we are committed to delivering exceptional pharmacy services that prioritize quality and patient care.Work Environment*NON REMOTE WORK*Schedule:Monday to Friday...

  • Claims Examiner

    3 days ago

    Madison, Wisconsin, United States Sedgwick Full time

    About the RoleSedgwick is seeking a highly skilled Claims Examiner - Liability Litigation to join our team. As a Claims Examiner, you will play a critical role in analyzing and processing complex claims to ensure timely and fair resolutions for our clients.Key ResponsibilitiesAnalyze and process claims through well-developed action plans to achieve timely...

  • Senior Claims Adjuster

    4 days ago

    Madison, Wisconsin, United States American Family Mutual Insurance Company Full time

    Job SummaryThis is a Senior-level role that involves investigating and managing complex property/casualty claims. The successful candidate will be responsible for determining liability, securing information, reviewing coverages, arranging appraisals, and settling third-party property liability claims.Key ResponsibilitiesInvestigate Claims Origin and Cause:...

  • Vehicle Warranty Claims Representative

    1 day ago

    Madison, Wisconsin, United States TEKsystems Full time

    About the RoleWe are seeking a highly skilled Warranty Claims Representative to join our team at TEKsystems. As a key member of our organization, you will play a critical role in ensuring the smooth operation of our warranty claims process.Key ResponsibilitiesReview and understand existing warranty contracts and terms to ensure accurate processing of...

  • Complex Claims Investigator

    6 days ago

    Madison, Wisconsin, United States American Family Insurance Full time

    Job SummaryThis is a Senior level role that involves investigating and managing complex property/casualty claims. The successful candidate will be responsible for determining liability, securing information, reviewing coverages, arranging appraisals, and settling third-party property liability claims.Key ResponsibilitiesInvestigation and Analysis: Conduct...

  • Pharmacy Order Processing Specialist

    2 weeks ago

    Madison, Wisconsin, United States BrightSpring Health Services Full time

    Company OverviewBrightSpring Health ServicesPosition SummaryBrightSpring Health Services is a recognized leader in the hospice sector, dedicated to delivering exceptional pharmacy solutions since the inception of the Medicare benefit in the 1980s. Our focus on quality and unparalleled service sets us apart in the industry.Work Environment*NON REMOTE...

  • Senior Claims Adjuster

    1 day ago

    Madison, Wisconsin, United States American Family Mutual Insurance Company Full time

    Job SummaryThis is a Senior-level role that involves investigating and managing complex property/casualty claims. The successful candidate will be responsible for determining liability, securing information, reviewing coverages, arranging appraisals, and settling third-party property liability claims.Key ResponsibilitiesInvestigation and Analysis:...

  • Pharmacy Order Processing Specialist

    2 weeks ago

    Madison, Wisconsin, United States BrightSpring Health Services Full time

    Company OverviewBrightSpring Health ServicesPosition SummaryBrightSpring Health Services is a recognized leader in the hospice sector, dedicated to delivering exceptional pharmacy solutions since the inception of the Medicare benefit in the 1980s. Our dedication to excellence and unparalleled service sets us apart in the industry.Work Environment*NON REMOTE...