Quality Appeal Coordinator, CVS Health

Quality Appeal Coordinator

CVS Health

Location:
United States, Work At Home, Florida

Category:
Customer Service

Contract Type:
Employment contract

Salary:

21.10 - 49.08 USD / Hour

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Job Description:

The Quality Appeal Coordinator coordinates reviews and evaluations for complaints and appeals received by the organization. This includes denied claims, coverage issues, medical necessity, service quality, or other concerns expressed by patients, providers, or other stakeholders. This person applies in-depth knowledge of subject matter and independently coaches others on matters regarding complaints and appeals.

Job Responsibility:

Handle quality checks for the appeals team, in order to ensure overall accuracy
Regularly trend quality errors for both the team and individuals
Hold coaching session for the team, in order to address any commonly occurring errors
Answer any and all questions related to appeals, as needed and designated
Assist in keeping relevant workflows up to date

Requirements:

2-4 years of experience in appeals
Knowledge of Microsoft Office products (Word, Excel, PowerPoint, Outlook)

Nice to have:

Prior experience working with claims
Prior experience in health insurance
Prior experience in compliance or auditing
Basic awareness of problem solving and decision-making skills

What we offer:

Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility

Additional Information:

Job Posted:
August 12, 2025

Expiration:
August 25, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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