Senior Coordinator, Complaints & Appeals Ops, CVS Health

Senior Coordinator, Complaints & Appeals Ops

CVS Health

Location:
United States, Work At Home, Georgia

Category:
Customer Service

Contract Type:
Not provided

Salary:

18.50 - 31.72 USD / Hour

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Job Description:

This position supports the daily processing of appeals in the Commercial Member Clinical Appeals (CMCA). Job functions include, completing appeals determination letters, intake and launching of expedited requests, updating systems, completing reporting as necessary, supporting the panel hearing process, working collaboratively with clinical support staff (Medical Directors, Nurses, Providers, etc.), triage of faxes, and movement of cases in the Complaints and Appeals Tracking System (CATS). All work is to be handled in compliance of turnaround times and regulatory standards.

Job Responsibility:

Completing appeals determination letters
Intake and launching of expedited requests
Updating systems
Completing reporting as necessary
Supporting the panel hearing process
Working collaboratively with clinical support staff (Medical Directors, Nurses, Providers, etc.)
Triage of faxes
Movement of cases in the Complaints and Appeals Tracking System (CATS)

Requirements:

Strong written and verbal communication
Ability to multi-task
Proficient in basic computer skills including Microsoft Office Suite
Knowledge of appeals process/appeals experience
High School Diploma

Nice to have:

Knowledge of appeals process/appeals experience

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:
June 14, 2025

Expiration:
June 17, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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