Senior Coordinator, Complaint and Appeals - Remote
CVS Health•Work At Home-Florida, FL
•$19 - $35•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.
- 1 year experience in patient management.
- 1 year experience in product, compliance and regulatory analysis.
- 1 year experience in special investigations.
- 1 year experience in provider relations.
- 1 year experience in customer service or audit experience.
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
- Manage to resolution complaint/appeal scenarios for all products.
- Coordinate responses from multiple business units for complex complaint/appeal scenarios.
- Ensure timely, customer-focused responses to complaints/appeals.
- Identify trends and emerging issues.
- Report identified trends and recommend solutions.
Benefits
- medical coverage
- dental coverage
- vision coverage
- paid time off
- retirement savings options
- wellness programs
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
Upload and Match Resume
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
