Appeals and Grievance Specialist

🔥 0 minutes ago

🌵 Arizona, Florida, +15 more states – Remote

🌵 Arizona – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote 🌾 Nebraska – Remote 🌾 North Dakota – Remote 🌪️ Oklahoma – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🏰 Missouri – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⚔️ Virginia – Remote 🧀 Wisconsin – Remote

💵 $45.9k - $68.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Medica

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1975

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Medica is a nonprofit health plan and insurer with over 50 years of experience that provides individual & family plans, Medicare, Medicaid, and employer-provided health plans. It offers member services and tools for finding providers, managing benefits and claims, wellness programs, and community-focused initiatives through the Medica Foundation to advance health equity.

📋 Description

• Manage and respond to member complaints, grievances, appeals, and some regulatory inquiries • Ensure accurate, timely, and compliant outcomes • Investigate complex case issues and conduct meaningful research • Clearly document findings and drive fair, compliant case determinations • Evaluate whether cases are clinical or non-clinical • Route cases to appropriate internal partners for resolution • Collaborate with Operations, Health Services, Legal, and Markets • Contribute to continuous improvement across the organization • Uphold regulatory compliance while delivering an exceptional member and provider experience • Perform other assigned duties

🎯 Requirements

• High school diploma or equivalent • 3 years of related work experience • Proficiency with Microsoft Word, Excel, and Outlook • Outstanding written and verbal communication skills • Strong problem-solving and analytical abilities • Ability to work effectively with staff at all levels, members, and providers • Ability to manage multiple priorities in a fast-paced environment • Must have a primary home address in AR, AZ, FL, GA, IA, IL, KS, KY, MI, MN, MO, ND, NE, OK, SD, TN, TX, VA, or WI • Must be legally authorized to work in the United States at the time of application • Medica does not offer work visa sponsorship for this role

🏖️ Benefits

• Competitive medical, dental, and vision benefits • PTO • Paid holidays • Paid volunteer time off • 401(k) contributions • Caregiver services • Incentive plan compensation may be available in addition to base salary