Appeals & Grievances Intake Coordinator II

Medica

. Review incoming appeals and grievances correspondence and identify the appropriate case type .

Posted 10/5/2026full-timeRemote • United StatesJuniorMid-Level💰 $41,300 - $61,950 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Appeals and Grievances processes, including case classification, regulatory compliance, and effective communication with members and providers. Proficient in maintaining accurate case records and documentation while adhering to quality standards in a healthcare operations environment.

Highest-signal resume keywords

Appeals & Grievances ExperienceCase ClassificationRegulatory ComplianceAttention to DetailHealthcare Operations Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Case Information EntryDocumentation VerificationData CollectionQuality AssuranceRegulatory Timeframe Assignment

Soft Skills

PrioritizationWorkload ManagementCommunication

Tools & Technologies

GuidingCareCare Management Platform

Industry Keywords

Healthcare OperationsManaged CareAppeals & GrievancesMedicareMedicaid

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

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