Associate Manager, Complaint & Appeals - Work From Home

Responsibilities

• Investigates and resolves appeals scenarios for all products, coordinating responses from multiple business units.
• Ensures timely, customer-focused responses to appeals.
• Identifies trends and emerging issues and reports and recommends solutions.
• Independently coaches others on complaints and appeals, ensuring compliance with Federal and/or State regulations.
• Manages control and trend inventory, independently investigating, changing, or revising policy to resolve escalated cases.
• Serves as the main point of contact for plan leadership, compliance, and State regulators as required.
• Collaborates with the clinical team and management for a fast turnaround of inventory.
• Adapts to changes due to regulatory updates and maintains attention to detail.

Qualifications

• Ability to interpret and understand regulatory guidance, member contract materials, and oversee inventory with strict time constraints.
• Experience in a fast-paced environment with 2+ years of leadership experience and project management skills.
• Previous appeals or related experience, with Medicare knowledge being a plus.

Benefits

The typical pay range for this role is $46,988.00 - $112,200.00. This position is eligible for a CVS Health bonus, commission, or short-term incentive program in addition to the base pay range listed above. Additional details about available benefits are provided during the application process and on Benefits Moments.