Regulatory and Appeals Advisor
Medica
full-time
Posted on:
Location Type: Remote
Location: Minnesota • Montana • United States
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Salary
💰 $45,900 - $68,775 per year
About the role
- 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.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Soft Skills
written communicationverbal communicationproblem-solvinganalytical abilitiescollaborationtime managementprioritization