Job description
The Appeals & Grievances Quality Auditor plays a key role in strengthening compliance, quality, and member experience across Medica's product lines. This position conducts audits of appeals and grievances cases, identifies trends and improvement opportunities, and partners with leadership to drive process enhancements and regulatory readiness.
The role provides reporting, training, and consultative support while helping shape audit best practices, improve operational effectiveness, and ensure adherence to regulatory and accreditation requirements. The ideal candidate brings strong analytical and problem-solving skills, along with expertise in health plan Appeals & Grievances operations and regulatory compliance.