Medica

Customer Support

• Supporting care coordination processes and documentation
• Receiving, managing, and entering authorizations and referrals from internal and external partners
• Managing care coordination and waiver assessment processes, including data entry
• Managing email inboxes and responding to inquiries
• Collaborating with internal stakeholders and cross-functional team members on ad-hoc requests or projects as assigned

Care Coordinated Products Support Specialist III

Compliance

• 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.

Care Coordinated Products Support Specialist III

Regulatory and Appeals Advisor