Employment Type: Full timeShift: Day Shift Description: This is a temporary, full‑time position with an expected duration to July 2026 Full time Monday through FridayWhy MediGold? MediGold is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries across the United States. We’re dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and more. Position Purpose: ​ The Appeals and Grievance Coordinator is responsible for the processing and resolution of appeals, grievances and disputes from members and providers What You Will Do: - Document all appeal requests or grievances upon receipt in the operating systems and routes cases to appropriate clinical personnel for review. - Obtain confidential medical records from providers offices utilizing secure methods. - Responsible for preparation of case files and review with clinical colleagues. - Screen all incoming grievances, appeals and provider claim dispute to ensure they are within compliance requirements of CMS guidelines and corporate policies. - Gather, analyze and report verbal and written member and provider complaints, grievances and appeals in accordance with Federal regulations and time constraints. - Conduct grievance and appeal investigations and provider claim dispute investigations through internal and external interviews, chart and contract audits, inspection, and interpretations of appropriate CMS guidance and policies. - Prepare background, case summary and case files with records for submission to the Independent Review Entity (IRE) and ensures that cases are compliant and required timeframes are met. - Obtain required documents and completely prepare cases for Appeals Committee (MAC) review, Administrative Law Judge (ALJ) Hearings. - Prepares and reviews data universes for the Centers for Medicare and Medicaid Services (CMS) audits. - Participates in regular monitoring efforts and reports trending and outliers to senior management. - Responsible for ensuring 5-Star (maximum) ratings from CMS for appeals and grievance related measures. STAR ratings have a direct correlation on payment methodology and reimbursement to the organization. - Maintain compliance of all regulatory requirements that apply to beneficiary protection areas of appeals and grievance. - All other duties as assigned. Minimum Qualifications: - Education: Bachelor’s degree or an equivalent combination of education and experience. - Experience: Three years of customer service experience or appeals and grievance experience, preferably in managed care (health insurance) or another health care setting. - Legal or regulatory background or experience highly desired - Strong written and verbal communication skills and demonstrated public speaker/educator desired. - Ability to interpret and apply Federal law and regulatory requirements ensuring compliance with Medicare Managed care obligations. - Ability to educate staff members, providers and enrollees about the appeals and grievance process. - Familiarity with claims processing, coordination of benefits and use of claims processing system. - Ability to follow Federal guidelines from CMS and Ohio Department of Insurance (ODI) for appeal and grievance resolution processes and requirements. Ministry/Facility Information: Mount Carmel, a member of Trinity Health, has been a transforming healing presence in Central Ohio for over 135 years. Mount Carmel serves over 1.3 million patients each year at our five hospitals, free-standing emergency centers, outpatient facilities, surgery centers, urgent care centers, primary care and specialty care physician offices, community outreach sites and homes across the region. Mount Carmel College of Nursing offers one of Ohio's largest undergraduate, graduate, and doctor of nursing programs. If you’re seeking a rewarding career where your purpose, passion, and desire to make a difference come alive, we invite you to consider joining our team. Here, care is provided by all of us For All of You! We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

• Provide coordination and administrative support to management and professional staff on processes or functional areas • Maintain files, run reports and track activities for the group • May observe and assist with assigned core activities • Perform functional area support for processes or functional areas

About the role: Darwin Homes is seeking a meticulous and process-oriented Construction Quality Control Associate to join our Turn Construction department. In this role, you will own the post-dispatch quality lane ensuring that every turn meets our rent-ready standards before a resident moves in. You will manage change-order visibility, coordinate final inspections, review proof-of-work submissions, and drive swift resolution of failed rent-ready inspections (RRIs). This role sits at the intersection of construction quality, vendor accountability, and leasing outcomes, and requires someone who takes ownership seriously and operates with urgency. What you'll do: - Own the post-dispatch stage of every turn, ensuring quality control checkpoints are completed accurately and on schedule. - Receive and track all change-order submissions, assessing downstream schedule impact and communicating risks to the Senior Manager and Quality Control Manager in real time. - Coordinate with the Quality Control Manager to determine final inspection readiness, ensuring no turn is submitted for inspection prematurely. - Conduct proof-of-work reviews for completed turns, verifying that vendor-submitted documentation aligns with the approved scope prior to inspection scheduling. - Manage all final inspection outcomes — categorizing results as Straight Pass, Pass With Punch, or Failed RRI — and drive appropriate follow-through for each. - Ensure Failed RRIs are resolved and re-inspected within 5 business days of notification, escalating unresolved items to the Senior Manager at day 3. - Track and report Pass With Punch cure timelines, holding vendors accountable to 24-hour completion targets. - Maintain accurate and current records in the turn management system (SuiteSpot) for all QC activity, inspection outcomes, and punch list statuses. - Collaborate cross-functionally with the Leasing team to communicate turn status and anticipated rent-ready dates. - Identify recurring quality failure patterns and contribute to vendor feedback and improvement processes. Requirements: - 2–3 years of experience in construction quality control, property management operations, or a related field. - Solid understanding of residential construction standards, including what constitutes rent-ready condition across key trade categories. - Ability to review and interpret proof-of-work documentation, scope completions, and vendor-submitted photos against approved standards. - Strong organizational skills with the ability to manage multiple active turns simultaneously at various stages of the QC process. - Clear and professional communication skills for vendor coordination, internal escalation, and cross-functional collaboration with Leasing. - Urgency-driven mindset with a strong sense of accountability for inspection timelines and move-in readiness. - Proficiency in construction or property management platforms (SuiteSpot experience a plus). Preferred Qualifications: - Prior experience managing rent-ready inspection workflows or coordinating with third-party inspection vendors. - Familiarity with SFR turn operations, including dispatch stages, change-order processes, and leasing-driven urgency. - Experience with proof-of-work review processes, including photo documentation standards and punch list management. - Background in vendor accountability, performance tracking, or quality assurance in a construction or maintenance context. Accommodation: Darwin Homes, Inc & Adoor Property Management Inc is committed to providing reasonable accommodations for qualified individuals with disabilities and ensuring accessibility in the workplace. If you require accommodation due to a disability to perform the essential functions of the job, please inform us at the time of application. Darwin Homes, Inc & Adoor Property Management Inc is an equal opportunity employer and makes employment decisions based on merit. We prohibit discrimination based on race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, genetic information, marital status, or any other characteristic protected by applicable laws. Darwin Homes, Inc complies with all applicable federal, state, and local laws regarding equal employment opportunity and strives to create a diverse and inclusive work environment for all employees.

• Collaborate with the agile team to design test cases for user stories and features. • Develop automated testing scenarios to evaluate new development. • Perform manual testing against acceptance criterion throughout the life of software projects. • Document and interpret results of testing, creating bugs and documenting future remediation work. • Report and track issues accurately and effectively. • Evaluate mid-project changes for testing impact. • Help improve QA processes making them more robust and efficient. • Work directly with clients to coordinate their User-Acceptance Testing (UAT).