Medica

Compensation

Full Description

Job Description: • Manage and respond to member complaints, grievances, contractual and clinical appeals, executive-level complaints, provider clinical appeals, and a wide range of regulatory inquiries. • Dig into complex case issues, conduct meaningful research, and clearly document your findings. • Evaluate whether each case is clinical or non-clinical and ensure it is routed to the appropriate internal partners for successful resolution. • Collaborate closely with teams across Operations, Health Services, Legal, and Markets. • Uphold Medica’s commitment to regulatory compliance while delivering an exceptional experience for members and providers. • Perform other duties assigned. Requirements: • High school diploma or equivalent • 3+ years of related work experience • Outstanding written and verbal communication skills • Strong problem-solving and analytical abilities to ensure timely and thorough case resolution • Ability to work effectively with staff at all levels, as well as members and providers • Demonstrated skill in managing multiple priorities in a fast-paced environment • Proficiency with Microsoft Word, Excel, and Outlook Benefits: • competitive medical • dental • vision • PTO • Holidays • paid volunteer time off • 401K contributions • caregiver services • many other benefits to support our employees.