Medica is seeking an Appeals & Grievances Specialist III to independently handle complex member complaints, grievances, and regulatory inquiries. You will apply advanced judgment across clinical, regulatory, and policy requirements while maintaining audit-ready documentation.
The role is remote with eligibility based on state employment locations. Ideal candidates have 3+ years in healthcare operations and 1+ year on an appeals/grievances team within a health plan.
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Level
Senior L5
Location
New York, NY
Occupation
Patient Representatives
Industry
Offices of Physicians (except Mental Health Specialists)
