Sr Coordinator, Complaints & Appeals Operations
CVS Health•Work At Home-Connecticut, CT
•$19 - $39
About The Position
This position supports the daily processing of appeals in Commercial Member Clinical Appeals (CMCA). The work includes preparing appeal determination letters; intake and launch of expedited requests; verbal expedited notifications and determinations; updating systems; completing reports; supporting panel hearings; collaborating with clinical support staff, including Medical Directors, nurses, and providers; triaging faxes; and moving cases through the Complaints and Appeals Tracking System (CATS). All work must comply with turnaround times and regulatory standards.
Requirements
- Familiarity with medical terminology.
- Strong written and verbal communication skills.
- Ability to multitask.
- Proficiency in basic computer skills, including Microsoft Office Suite.
- High school diploma.
Nice To Haves
- Knowledge of the appeals process or appeals experience.
- Prior experience working in a medical setting.
Responsibilities
- Complete appeal determination letters.
- Intake and launch expedited requests.
- Provide verbal expedited notifications and determinations.
- Update systems and complete reporting as necessary.
- Support the panel hearing process.
- Work collaboratively with clinical support staff, including Medical Directors, nurses, and providers.
- Triage faxes.
- Move cases through the Complaints and Appeals Tracking System (CATS).
- Handle all work in compliance with turnaround times and regulatory standards.
Benefits
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources, based on eligibility
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
