Senior Coordinator, Complaint & Appeals - Remote

Overview

The Senior Coordinator for Complaint & Appeals at CVS Health is responsible for managing complex Fast Track Appeal scenarios for Medicare products, ensuring resolution while collaborating with multiple business units.

In Short

• Manage Fast Track Appeal scenarios for Medicare products.
• Act as a subject matter expert, providing training and coaching.
• Research and resolve complex appeals and denial determinations.
• Coordinate responses across departments for effective issue resolution.
• Identify trends in misrouted work and improve processes.
• Deliver internal quality reviews and support audits.
• Educate team members on complaints and appeals processes.
• Ensure compliance with established timeframes for appeals.
• Serve as a point of contact for Fast Track appeals.
• Provide support in regulatory and customer meetings.

Requirements

• Knowledge of Fast Track Appeals and CMS Guidelines.
• 2-3 years of experience in Medicare platforms and benefits.
• Experience in compliance and regulatory analysis.
• Proficient in MS Word and MS Excel.
• Familiarity with MHK, QuickBase, and Avaya System.
• Strong research and analysis skills.
• HS Diploma or equivalent experience required.

Benefits

• Comprehensive medical, dental, and vision coverage.
• Paid time off and retirement savings options.
• Wellness programs and resources.
• Support for physical, emotional, and financial well-being.