Remote Appeals & Grievances Intake Coordinator II

Medica; Phoenix (AZ); Remote; USD 41,000 - 71,000; Full time

Job summary

Medica is seeking an Appeals & Grievances Intake Coordinator II to handle intake, case entry, and routing for member and provider appeals and grievances. Responsibilities include applying guidelines to classify cases, entering data accurately, and routing to the correct teams to support timely processing.

Your role supports regulatory compliance and a positive member experience through precise documentation, timely responses, and clear communications.

Qualifications

• High School Diploma or equivalent.
• 2+ years of related work experience in health plan/managing care environments.
• Minimum 1+ years in Appeals & Grievances (A&G) on a dedicated team.
• Ability to prioritize a high-volume workload with accuracy.
• Strong attention to detail to classify appeals and determine timelines.

Responsibilities

• Perform Intake, Case Entry, and Routing for Appeals & Grievances (A&G) Correspondence.
• Review incoming correspondence and apply criteria to identify the appropriate case type.
• Enter accurate and complete case information into designated systems.
• Assign regulatory and operational timeframes based on procedures.
• Route correspondence to the appropriate work queue or team for timely resolution.
• Respond to Member & Provider Inquiries Regarding A&G Processes.
• Assist members and providers in understanding documentation and submission expectations.
• Research routine case questions using available resources and systems.
• Escalate complex issues to appropriate staff for review.
• Verify case information to support accurate outgoing communications.
• Identify and correct routine documentation errors prior to distribution.

Skills

Attention to detail

Prioritization

Regulatory awareness

Education

High School Diploma or equivalent

2+ years in health plan/managed care operations

Tools

GuidingCare

Job description

Medica is seeking an Appeals & Grievances Intake Coordinator II to handle intake, case entry, and routing for member and provider appeals and grievances. Responsibilities include applying guidelines to classify cases, entering data accurately, and routing to the correct teams to support timely processing.

Your role supports regulatory compliance and a positive member experience through precise documentation, timely responses, and clear communications.