Medica

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.

Regulatory and Appeals Advisor

Manager

• Provide a member-centric, evidence-based model of care across multiple products
• Conduct comprehensive assessments
• Develop, implement, and monitor individualized care plans
• Coordinate services across the healthcare continuum

Complex Case Manager III

Full-stack Engineer

• Assess existing systems and integrations to understand current capabilities, gaps, and areas for improvement
• Lead system design and architecture decisions to build secure, scalable, and reliable solutions
• Provide hands-on technical expertise in backend and frontend development while setting engineering best practices
• Partner with product, infrastructure, and business teams to define technology roadmaps and implementation plans
• Mentor and guide development teams, fostering a culture of quality, collaboration, and continuous improvement
• Communicate technical strategies and recommendations clearly to non-technical stakeholders and leadership teams

Regulatory and Appeals Advisor

Complex Case Manager III

Lead Software Engineer – Eligibility