Senior Coordinator, Complaint & Appeals
About The Position
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. 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, patient management, product, compliance and regulatory analysis, special investigations, provider relations, 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
- 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.
Benefits
- medical
- dental
- vision coverage
- paid time off
- retirement savings options
- wellness programs
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
High school or GED
