Coordinator, Complaint & Appeals - Remote
CVS Health•Jacksonville, FL
•Remote
About The Position
Responsible for managing to resolution complaint/appeal scenarios for all products, which may contain multiple issues and may require coordination of responses from multiple business units. Ensure timely, customer focused response to complaints/appeals. Identify trends and emerging issues and report and recommend solutions. This position can be anywhere in the United States.
Requirements
- 1 year experience that includes both HMO and Traditional claim platforms, products, and benefits.
- Experience in patient management.
- Experience in product, compliance and regulatory analysis.
- Experience in special investigations.
- Experience in provider relations.
- Experience in customer service.
- Experience in audit.
Nice To Haves
- Medicare experience
- Claims experience
- Experience in reading or researching benefit language in Summary Plan Description (SPDs) or Certificate of Coverage (COCs)
- Experience in research and analysis of claim processing a plus.
Responsibilities
- Managing to resolution complaint/appeal scenarios for all products.
- Coordinating responses from multiple business units for complaint/appeal scenarios.
- Ensuring timely, customer-focused responses to complaints/appeals.
- Identifying trends and emerging issues.
- Reporting and recommending solutions for identified trends and issues.
Benefits
- medical coverage
- dental coverage
- vision coverage
- paid time off
- retirement savings options
- wellness programs
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
