Senior Coordinator Complaint & Appeals, CVS Health

CVS Health

Location:
United States, Work At Home

Category:
Customer Service

Contract Type:
Employment contract

Salary:

18.50 - 42.35 USD / Hour

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Job Description:

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Job Responsibility:

Researching and resolving Medicare complaints received via the Centers for Medicaid and Medicare Services (CMS)
Managing a queue of Medicare complaints
Identifying the Medicare beneficiary’s complaint
Researching Plan systems to identify the issue
Partnering with other business departments to correct any potential issue
Determining root cause
Bringing final resolution to the complaint
Making outbound calls to both beneficiaries and providers to resolve their complaint

Requirements:

Excellent communication skills, both verbal and oral
Excellent problem-solving skills and critical thinking ability
Time management skills
Experience handling customer calls and elevated issues
Ability to document resolution in written communication to beneficiaries in a professional and easy to understand manner
Experience troubleshooting complex customer problems
Attention to detail
Ability to work across various departments as necessary to establish the root cause and resolution of the issue
Ability to toggle between multiple applications
Ability to manage complaint caseload effectively
Ability to work flexible hours, some weekends and holidays
Overtime may be required during busy times of year

Nice to have:

Experience with Microsoft Office Suite, Word, Outlook and Excel
General Medicare knowledge/experience
Prior experience with complaints and/or Center for Medicare and Medicaid Services (CMS)
Medical/RX claim processing knowledge
Bachelors Degree

What we offer:

Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
August 13, 2025

Expiration:
August 25, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Senior Coordinator Complaint & Appeals