Remote Appeals & Grievances Specialist

Medica Services Company LLC; Minnetonka (MN); Remote; USD 46,000 - 69,000; Full time

Job summary

Medica is seeking an Appeals and Grievance Specialist to manage member complaints, grievances, and regulatory inquiries, ensuring timely, accurate, and compliant resolutions.

You will determine whether cases are clinical or non-clinical, route them to the appropriate internal partners, and collaborate with Operations, Health Services, Legal, and Markets. This is a remote position with a competitive total rewards package.

Qualifications

• High school diploma or equivalent required.
• At least 3 years of related work experience.
• 3–5+ years in appeals/grievances, healthcare operations, insurance, or related field preferred.

Responsibilities

• Manage and respond to member complaints and appeals.
• Determine clinical vs non-clinical cases and route appropriately.
• Collaborate with Operations, Health Services, Legal, and Markets.
• Ensure timely, accurate, and compliant resolutions.

Skills

Written and verbal communications

Analytical thinking

Cross-functional collaboration

Ability to manage multiple priorities

Stakeholder communication

Education

High school diploma or equivalent

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

Medica is seeking an Appeals and Grievance Specialist to manage member complaints, grievances, and regulatory inquiries, ensuring timely, accurate, and compliant resolutions.

You will determine whether cases are clinical or non-clinical, route them to the appropriate internal partners, and collaborate with Operations, Health Services, Legal, and Markets. This is a remote position with a competitive total rewards package.