Appeals & Grievances Intake Coordinator II

🔥 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

💵 $41.3k - $62k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

🦅 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

• Review incoming appeals and grievances correspondence and identify the appropriate case type • Enter accurate and complete case information into designated systems • Assign regulatory and operational timeframes according to established procedures • Route correspondence to the appropriate work queue or team • Provide members and providers with information about appeals and grievance procedures, timelines, and requirements • Assist members and providers with documentation and submission expectations • Research routine case questions using available resources and systems • Escalate complex issues or concerns for further review • Verify case information for accurate outgoing communications • Ensure correspondence reflects appropriate case status, timelines, and required content • Identify and correct routine documentation errors • Coordinate with internal partners to obtain missing information • Maintain case records and documentation according to regulatory and organizational standards • Assist with data collection and reporting • Follow policies, procedures, and quality requirements • Participate in training and process improvement activities • Perform other duties as assigned

🎯 Requirements

• High School Diploma or equivalent • 2+ years of related work experience in a health plan, managed care, healthcare operations, or related environment • Minimum 1+ years of Appeals & Grievances (A&G) experience working on a dedicated Appeals & Grievances team • Experience reviewing and classifying appeals, grievances, or other healthcare-related correspondence according to established guidelines • Ability to prioritize and manage a high-volume workload while maintaining quality and accuracy standards • Strong attention to detail • Ability to accurately determine case types and assign appropriate regulatory and operational turnaround times • Must be legally authorized to work in the United States at the time of application • No work visa sponsorship available • Primary home address must be within a 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 • Preferred: 2+ years of Appeals & Grievances intake experience within a health insurance or managed care organization • Preferred: Experience determining appeal or grievance classifications and corresponding regulatory timelines • Preferred: Experience using GuidingCare or a similar care management/case management platform • Preferred: Knowledge of Medicare, Medicaid, and commercial health plan appeals and grievance regulations

🏖️ Benefits

• Medical insurance • Dental insurance • Vision insurance • PTO • Holidays • Paid volunteer time off • 401K contributions • Caregiver services • Other total rewards benefits