Appeals and Grievances Manager

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

Medica’s Appeals and Grievances Manager supports the day‑to‑day operations of the Appeals and Grievances team, ensuring work is completed accurately, on time, and in compliance with regulatory requirements. This role keeps the team running smoothly by supporting supervisors, handling escalated or highly visible issues, and assisting with audits, reporting, and process improvements. This role is critical to ensuring the Appeals and Grievances team operates effectively and consistently, allowing leadership to focus on strategy while maintaining high service and regulatory standards. Performs other duties assigned.

Key Accountabilities

• Oversee daily department operations to ensure cases are handled timely and accurately
• Provide leadership, guidance, and support to supervisors, including one‑on‑ones and team meetings
• Ensure compliance with applicable regulatory and accreditation requirements (CMS, NCQA, and state regulations)
• Assist with audits and regulatory reviews, including reporting and documentation preparation
• Monitor grievance and appeal trends and identify improvement opportunities
• Support supervisors and staff with escalated, complex, or high‑visibility cases
• Partner with regulatory, clinical, and cross‑functional teams to resolve issues and improve processes
• Drive consistency, accountability, and effective execution across the team
  
  

Required Qualifications

• Associate’s degree or equivalent combination of education and experience
• 5 years of related professional experience
• Prior leadership experience in claims, enrollment, billing, or customer service
  
  

Preferred Qualifications

• Experience in health insurance, managed care, appeals and grievances, regulatory compliance, or a related field
• Familiarity with CMS, NCQA, and state regulatory requirements
  
  

Skills And Abilities

• Strong operational and organizational skills
• Ability to manage complex, regulated work in a fast‑paced environment
• Comfortable handling escalated and sensitive issues
• Clear communicator who can work across teams and leadership levels
• Ability to lead through change and identify process improvement
  
  

This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, Madison, MN, Omaha, NE, and St. Louis, MO.

The full salary grade for this position is $70,200 - $120,400. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $70,200 - $105,315. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data.  In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica’s compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.