[Hiring] Appeals & Grievances Intake Coordinator II @Medica

Role Description

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.

• 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.

Qualifications

• 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
• Demonstrated experience reviewing and classifying appeals, grievances, or other healthcare-related correspondence according to established guidelines
• Proven ability to prioritize and manage a high-volume workload while maintaining quality and accuracy standards
• Strong attention to detail with the ability to accurately determine case types and assign appropriate regulatory and operational turnaround times

Requirements

• 2+ years of Appeals & Grievances intake experience within a health insurance or managed care organization
• Experience determining appeal or grievance classifications and corresponding regulatory timelines
• Experience using GuidingCare or a similar care management/case management platform
• Knowledge of Medicare, Medicaid, and commercial health plan appeals and grievance regulations

Benefits

• Competitive medical, dental, vision
• PTO, Holidays, paid volunteer time off
• 401K contributions
• Caregiver services
• Many other benefits to support our employees