Remote Senior Appeals & Grievances Specialist

Medica; Minnetonka (MN); À distance; USD 46 000 - 79 000; Plein temps

Avantages offerts par ce poste

Medical benefits

Dental benefits

Vision benefits

PTO

Holidays

Volunteer time off

401K contributions

Caregiver services

Résumé du poste

Medica, a nonprofit health plan serving communities across multiple states, seeks a remote Appeals & Grievances Specialist III to manage complex member complaints, grievances, and appeals with regulatory alignment. You will work with cross-functional teams to ensure timely, accurate resolutions and audit-ready documentation in support of compliant care.

Ideal candidates have 3+ years in healthcare operations and at least 1 year on a dedicated appeals/grievances team, with strong regulatory

Qualifications

• 3+ years of work experience in healthcare operations or related field.
• 1+ years direct experience on a dedicated appeals/grievances team within a health plan.
• Familiarity with CMS guidelines and regulatory agencies is a plus.

Responsabilités

• Review and resolve complex or high-risk member complaints, grievances, and appeals.
• Maintain audit-ready documentation and ensure regulatory and policy compliance.
• Draft accurate responses to regulatory inquiries and coordinate with stakeholders.
• Guide peers, share trends, and support continuous process improvements.
• Monitor timelines and escalate risks as needed to leadership.

Connaissances

Healthcare operations

Appeals & grievances

Regulatory compliance

Formation

High School Diploma or equivalent

Description du poste

Medica, a nonprofit health plan serving communities across multiple states, seeks a remote Appeals & Grievances Specialist III to manage complex member complaints, grievances, and appeals with regulatory alignment. You will work with cross-functional teams to ensure timely, accurate resolutions and audit-ready documentation in support of compliant care.

Ideal candidates have 3+ years in healthcare operations and at least 1 year on a dedicated appeals/grievances team, with strong regulatory