Senior Coordinator, Complaint & Appeals - Remote

Position Summary

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Duties

• 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 appeals ensuring compliance with Federal and/or State regulations.
• Manages control and trend inventory, independently investigating and adapting to changes or revising policies to resolve escalated cases.
• Serves as the point of contact for leadership, compliance, and State regulators regarding appeals.
• Understands and adapts to departmental processes and policies.
• Medicare knowledge is a plus.
• Carries a modified case load including serving as a content model expert and mentor to the team, ensuring work meets federal and state requirements and quality measures.
• Successfully works across functions, segments, and teams to create, populate, and trend reports to find resolution to escalated cases.
• Identifies potential risks and cost implications to avoid incorrect or inaccurate responses and/or decisions which may result in additional rework, confusion to constituents, or legal ramifications.

Requirements

• At least 2+ years in one of the following areas: claim platforms, products, and benefits; patient management; product or contract drafting; compliance and regulatory analysis; special investigations; provider relations; customer service or audit experience.
• Some Medicare and/or Medicaid knowledge.
• Experience in reading or researching benefit language.
• Ability to work in fast-paced, high-volume environments.
• Excellent verbal and written communication skills.
• Excellent organizational skills to handle high inventory which aids in meeting or exceeding metrics.
• Solution-driven and can handle complex issues with accuracy.

Qualifications

• High School or GED.

Pay

The Typical Pay Range For This Role Is $18.50 - $35.29 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.

Benefits

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great Benefits For Great People We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.