Appeals & Grievances Intake Coordinator II

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

The Appeals & Grievances Intake Coordinator II performs intake, case entry, and routing activities for member and provider appeals and grievances to support timely and accurate case processing. The role applies working knowledge of Appeals & Grievances procedures, regulatory requirements, products, and systems to identify case types, assign appropriate deadlines, and ensure complete documentation.

Working under general supervision, the position follows established processes while resolving routine issues and escalating complex situations as needed. Through accurate case handling and responsive customer service, the role contributes to regulatory compliance and a positive member and provider experience. Performs other duties as assigned.

Key Accountabilities

Perform Intake, Case Entry, & Routing for Appeals & Grievances (A&G) Correspondence

• Review incoming correspondence and apply established criteria to identify the appropriate case type.
• Enter accurate and complete case information into designated systems.
• Assign required regulatory and operational timeframes based on defined procedures.
• Route correspondence to the appropriate work queue or team for timely resolution.

Respond to Member & Provider Inquiries Regarding A&G Processes

• Provide accurate information regarding appeals and grievance procedures, timelines, and requirements.
  
• Assist members and providers in understanding documentation and submission expectations.
  
• Research routine case questions using available resources and systems.
  
• Escalate complex issues or concerns to appropriate staff for further review.

Review & Prepare Correspondence for Accuracy & Completeness

• Verify case information to support accurate outgoing communications.
  
• Ensure correspondence reflects appropriate case status, timelines, and required content.
  
• Identify and correct routine documentation errors prior to distribution.
  
• Coordinate with internal partners to obtain missing information when needed.

Support Departmental Compliance, Documentation, & Administrative Activities

• Maintain case records and documentation in accordance with regulatory and organizational standards.
  
• Assist with data collection and reporting activities to support operational needs.
  
• Follow established policies, procedures, and quality requirements during daily work.
  
• Participate in training and process improvement activities to enhance accuracy and efficiency.
  
• Other duties as assigned.

Required Qualifications

• High School Diploma or equivalent
• 2+ years of related work experience a health plan, managed care, healthcare operations, or related environment
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  Minimum 1+ years of Appeals & Grievances (A&G) experience working on a dedicated Appeals & Grievances team

  
  
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  Demonstrated experience reviewing and classifying appeals, grievances, or other healthcare-related correspondence according to established guidelines

  
  
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  Proven ability to prioritize and manage a high-volume workload while maintaining quality and accuracy standards

  
  
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  Strong attention to detail with the ability to accurately determine case types and assign appropriate regulatory and operational turnaround times

  
  

Preferred Qualifications

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  2+ years of Appeals & Grievances intake experience within a health insurance or managed care organization

  
  
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  Experience determining appeal or grievance classifications and corresponding regulatory timelines

  
  
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  Experience using GuidingCare or a similar care management/case management platform

  
  
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  Knowledge of Medicare, Medicaid, and commercial health plan appeals and grievance regulations

  
  

This position is a Remote role.To be eligible for consideration, candidates must have a primary home address located within any 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

The full salary grade for this position is $41,300 - $70,800. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $41,300 - $61,950. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.