Appeals & Grievances Intake Coordinator II

This is a fully remote position, open to applicants in Arizona, +16 more states.

📋 Description

• Review incoming appeals and grievances correspondence to determine the correct case type.

• Accurately input complete case information into designated systems.

• Assign regulatory and operational timelines in accordance with established procedures.

• Direct correspondence to the relevant work queue or team.

• Provide members and providers with information regarding appeals and grievance procedures, timelines, and requirements.

• Assist members and providers with documentation and submission expectations.

• Research common case inquiries using available resources and systems.

• Escalate complex issues or concerns for further examination.

• Verify case information for accurate outgoing communications.

• Ensure correspondence accurately reflects case status, timelines, and required content.

• Identify and rectify routine documentation errors.

• Coordinate with internal partners to acquire missing information.

• Maintain case records and documentation in compliance with regulatory and organizational standards.

• Assist with data collection and reporting efforts.

• Adhere to policies, procedures, and quality requirements.

• Engage in training and process improvement initiatives.

• Perform additional duties as assigned.

⛳️ Requirements

• High School Diploma or equivalent.

• 2+ years of relevant work experience in a health plan, managed care, healthcare operations, or a similar environment.

• At least 1+ years of experience on a dedicated Appeals & Grievances (A&G) team.

• Experience in reviewing and classifying appeals, grievances, or other healthcare-related correspondence based on established guidelines.

• Capability to prioritize and manage a high-volume workload while upholding quality and accuracy standards.

• Strong attention to detail.

• Ability to accurately identify case types and assign suitable regulatory and operational turnaround times.

• Must be legally authorized to work in the United States at the time of application.

• No work visa sponsorship is 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 intake experience in Appeals & Grievances within a health insurance or managed care organization.

• Preferred: Experience in determining appeal or grievance classifications and corresponding regulatory timelines.

• Preferred: Familiarity with 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.