Senior Coordinator Complaint Appeals Operations - Remote

Overview

The Senior Coordinator Complaint Appeals Operations at CVS Health is responsible for managing complex appeal scenarios for various products, ensuring resolution through coordination with multiple business units.

In Short

• Manage resolution of complex appeal scenarios.
• Act as a subject matter expert for training and coaching.
• Research and resolve electronic appeals as a single point of contact.
• Identify and reroute inappropriate work items.
• Assemble data for denial determinations.
• Review clinical determinations and claims processing logic.
• Coordinate cross-department efforts to resolve complaints and appeals.
• Identify trends and report potential solutions.
• Deliver internal quality reviews and support audits.
• Respond to executive complaints and regulatory inquiries.

Requirements

• 1-2 years Medicare part C Appeals experience.
• 1 year experience in reading benefit language.
• 1 year experience in research and analysis of claims.
• Excellent verbal and written communication skills.
• Strong leadership skills and multitasking ability.
• Experience documenting workflows.
• Strong customer service skills.

Benefits

• Competitive wages and comprehensive benefits.
• 401(k) plan with matching contributions.
• No-cost wellness programs.
• Flexible work schedules and paid time off.
• Tuition assistance and financial coaching.