Senior Analyst, Complaints & Appeals (Project Management) - Remote
About The Position
The Senior Analyst, Project Management supports the Root Cause Corrective Action (RCCA) program by coordinating cross-functional issue resolution, supporting root cause analysis, tracking remediation, and assessing operational and business impacts. The role partners with stakeholders across Claims, Grievances, Appeals, Compliance, Clinical, and Operations to identify recurring issue drivers, support governance, develop reporting and analytical solutions, and advance sustainable process improvements. The position supports the Claims, Grievances and Appeals leadership team and includes project coordination, stakeholder engagement, executive reporting, documentation management, and data-driven recommendations to improve operational performance and member outcomes. The Senior Analyst leads and manages cross-functional projects within scope, timelines, and budget; coordinates RCCA stakeholders and corrective actions; supports issue validation, trend analysis, and corrective action planning; and quantifies business impact. The role also validates root cause findings, assesses remediation effectiveness and sustainability, identifies operational defects and compliance or control risks, and recommends improvements. Additional work includes supporting process optimization and regulatory initiatives, maintaining program documentation and training resources, planning and monitoring projects, escalating barriers and risks, communicating status, and applying project management and continuous improvement practices.
Requirements
- 3–5 years of experience in healthcare operations.
- Strong analytical, problem-solving, and critical thinking skills, with experience in root cause analysis, trend analysis, and process improvement.
- Experience supporting governance programs, remediation tracking, issue management, and corrective action planning.
- Ability to analyze data, quantify business impact, and develop actionable recommendations.
- Experience creating executive-level reports, dashboards, presentations, and business communications.
- Strong communication and stakeholder management skills, including the ability to explain complex issues to diverse audiences.
- Ability to support cross-functional initiatives, influence stakeholders, and drive results in a matrixed environment.
- Advanced proficiency in Microsoft Excel, PowerPoint, and data analysis/reporting tools.
- Ability to work independently, manage multiple priorities, and execute with minimal supervision.
Nice To Haves
- Proficiency with QuickBase or similar workflow management platforms.
- Experience in Medicare Advantage, Part D, Commercial Appeals, Provider Appeals, Claims, Grievance, or CTM operations.
- Experience with governance, remediation tracking, root cause analysis, and operational improvement initiatives.
- Experience with reporting, analytics, automation, or business intelligence solutions.
- Experience supporting executive reporting and operational performance reviews.
- CAP, PMP, Lean Six Sigma, or related certification preferred.
- Bachelor's degree preferred, or equivalent combination of education, professional experience, and relevant healthcare operational expertise.
Responsibilities
- Lead and manage cross-functional projects, ensuring planning, execution, and delivery within scope, timeline, and budget.
- Coordinate RCCA issue stakeholders, monitor remediation progress, and support timely completion of corrective actions.
- Assist with root cause analysis, including issue identification and validation, trend analysis, corrective action planning, and recommendations addressing recurring complaint, grievance, and appeal drivers.
- Partner with business stakeholders to quantify issue impact, analyze operational data, and report on risk, customer impact, and remediation outcomes.
- Support governance by validating root cause findings, tracking remediation effectiveness, and evaluating the sustainability of corrective actions.
- Identify operational defects, process gaps, compliance risks, and control weaknesses, and recommend improvements to quality, efficiency, and customer experience.
- Collaborate with Operations, Compliance, Clinical, Claims, Appeals, Provider/Network, Product, Technology, and Configuration teams to resolve issues and improve processes.
- Support initiatives focused on process optimization, regulatory compliance, reporting enhancements, operational effectiveness, and reducing recurring issue drivers.
- Develop and maintain process documentation, governance materials, job aids, training resources, and operational guidance.
- Support project planning, risk identification, milestone tracking, and stakeholder communications for RCCA-related initiatives.
- Monitor projects and remediation activities, identify execution barriers, escalate risks, and provide regular status updates to leadership and stakeholders.
- Apply project management methodologies, governance standards, and continuous improvement practices to enhance program effectiveness and operational outcomes.
Benefits
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources, based on eligibility
- Eligible for a CVS Health bonus, commission, or short-term incentive program in addition to base pay
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What This Job Offers
Job Type
Full-time
Career Level
Senior
