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Senior Coordinator, Complaint & Appeals at CVS Health
Cacao, French Guiana, France - Full Time
Skills Needed
Problem Solving, Decision Making, Compliance, Internal Audits, Data Analysis, Team Oversight, Training Development, Mentoring, Regulatory Requirements, Appeals Process, Grievances Management, Performance Metrics, Patient Interaction, Report Preparation, Policy Implementation
Specialization
Candidates should have 2-5 years of work experience and be adept at problem solving and decision making. A high school diploma is required for this position.
Experience Required
Minimum 2 year(s)
Executive Director, Regulatory Affairs at CVS Health
São Paulo, São Paulo, Brazil - Full Time
Skills Needed
Pharmacy, Healthcare, Regulatory Affairs, Communication Skills, Organizational Skills, Problem Solving Skills, Executive Presence, Business Judgment, Interpersonal Skills, Mentoring, Collaboration, Analytical Skills, Advocacy, Compliance, Leadership, Strategic Planning
Specialization
Candidates must possess a Pharmacy Degree and have over 8 years of experience in pharmacy and healthcare, particularly in regulatory laws. Strong communication skills and the ability to influence decision-making are essential.
Experience Required
Minimum 10 year(s)
Advanced Pharmacy Technician Back End (IV Infusion), Omnicare (Overnight) F at CVS Health
Town "n" Country, Florida, United States - Full Time
Skills Needed
Pharmacy Technician, Medication Fulfillment, Regulatory Compliance, Order Fulfillment, Packaging, Dispensing, Inventory Management, Customer Service, Team Coordination, Stock Rotation, Delivery Coordination, Compounding, Narcotics Management, Iv Infusion, Long Term Care, Quality Assurance
Specialization
Candidates must be certified or licensed pharmacy technicians with at least one year of experience. Preferred qualifications include experience in long-term care and PTCB National Certification.
Experience Required
Minimum 2 year(s)
Cashier at SSM Health
Oklahoma City, Oklahoma, United States - Full Time
Skills Needed
Cash Handling, Customer Service, Cash Register Operation, Payment Processing, Balancing Cash Receipts, Stocking Merchandise, Organizing Checkout Area, Data Entry
Specialization
No prior experience is required for this position. Physical requirements include frequent lifting and movement, as well as the ability to communicate effectively.
RN-Charge Nurse, Surgery (WO) at SSM Health
St. Louis, Missouri, United States - Full Time
Skills Needed
Leadership, Patient Care, Staff Management, Collaboration, Performance Evaluation, Patient Assessment, Quality Outcomes, Complaint Management, Training, Development, Communication, Safety, Nursing, Surgery, Education, Monitoring
Specialization
Candidates must be graduates of an accredited nursing school and have at least one year of registered nurse experience. Physical requirements include constant standing and walking, as well as frequent lifting and communication.
Medical Assistant at CVS Health
Indianapolis, Indiana, United States - Full Time
Skills Needed
Medical Assistant Certification, Patient Care, Vital Signs, Screenings, Medication Reviews, Telephonic Support, Vaccinations, Point Of Care Tests, Electronic Medical Record, Computer Skills, Problem Solving, Communication Skills, Customer Service, Attention To Detail, Flexibility, Team Collaboration
Specialization
Candidates must have state or national certification or graduation from an accredited medical assistant course, along with at least one year of experience. CPR or BLS certification and electronic medical record experience are also required.
Experience Required
Minimum 2 year(s)
Dentist at PDS Health
Snohomish, Washington, United States - Full Time
Skills Needed
N/A
Specialization
Candidates should have a dental degree and relevant licensure. Experience in a clinical setting is preferred.
Per Diem - Anesthesiology at UVA Health
, Virginia, United States - Full Time
Skills Needed
Anesthesiology, Patient Management, Medical Procedures, Health Assessments, Diagnostic Studies, Emergency Therapy, Medication Ordering, Consultation Requests, Patient Education, Quality Standards, Professional Development, Team Collaboration, Documentation, Cpt Coding, Icd Coding, Continuing Education
Specialization
Candidates must be graduates of an accredited medical school with an MD or DO degree and have completed an accredited residency in their chosen specialty. Board certification is required, and an unrestricted license to practice in Virginia must be maintained.
Shift Supervisor at CVS Health
, , United States - Full Time
Skills Needed
Management, Customer Service, Communication, Supervision, Analytical Skills, Deductive Reasoning, Computer Skills, Problem Solving, Team Leadership, Retail Experience, Merchandising, Inventory Management, Conflict Resolution, Time Management, Flexibility, Customer Relations
Specialization
Candidates should possess deductive reasoning, analytical, and computer skills, along with advanced communication and supervision abilities. A flexible schedule is required, including early morning, overnight, and weekend shifts.
Shift Supervisor at CVS Health
Falls Church, Virginia, United States - Full Time
Skills Needed
Management, Customer Service, Communication, Supervision, Analytical Skills, Deductive Reasoning, Computer Skills, Problem Solving, Team Leadership, Retail Experience, Merchandising, Inventory Management, Conflict Resolution, Time Management, Flexibility, Customer Relations
Specialization
Candidates should possess deductive reasoning, analytical, and computer skills, along with advanced communication and supervision abilities. Retail supervisory experience is preferred, and a high school diploma is preferred but not required.
Scheduler 40 hours at SSM Health
Monroe, Wisconsin, United States - Full Time
Skills Needed
Scheduling, Data Entry, Patient Services, Communication, Compliance, Documentation, Referral Coordination, Customer Service
Specialization
A high school diploma or GED is required, or 10 years of work experience. No prior experience is necessary for this position.
JANITORIAL at NEW Health
Suncrest, Washington, United States - Full Time
Skills Needed
Cleaning Equipment, Sanitization, Dusting, Trash Collection, Floor Maintenance, Infection Control, Attention To Detail, Time Management
Specialization
A high school diploma or GED is required, along with previous janitorial experience preferred. Knowledge of cleaning equipment and chemicals is necessary, and the role may require working evenings and weekends.
Respiratory Therapist at SSM Health
Oklahoma City, Oklahoma, United States - Full Time
Skills Needed
Patient Assessment, Respiratory Care, Patient Education, Equipment Maintenance, Emergency Response, Medication Administration, Care Plan Development, Monitoring Patient Condition
Specialization
An Associate's degree in Respiratory Care or equivalent experience is required, with no prior experience necessary. Candidates must hold relevant certifications such as BLS HCP and RRT, depending on the state of work location.
RN Cardiac Med Surg PRN at SSM Health
Fond du Lac, Wisconsin, United States - Full Time
Skills Needed
Compassion, Patient Care, Nursing Practice, Assessment Skills, Communication, Leadership, Collaboration, Education, Advocacy, Holistic Care, Cultural Sensitivity, Evidence Based Practice, Teamwork, Critical Thinking, Problem Solving
Specialization
Graduate of an accredited school of nursing is required, with no prior experience necessary. Candidates must hold a valid RN license and BLS certification.
Store Manager in Training at CVS Health
, , United States - Full Time
Skills Needed
Communication, Customer Care, Merchandising Strategies, Inventory Management, Leadership, Team Engagement, Sales Growth, Profitability Management
Specialization
Candidates are expected to have a high school diploma or GED, with a bachelor's degree preferred. Retail management experience or experience as a CVS Supervisor is also required.
Pharmacy Technician at CVS Health
San Diego, California, United States - Full Time
Skills Needed
Customer Service, Communication Skills, Mathematical Reasoning, Problem Resolution, Attention To Detail, Team Orientation, Flexibility, Empathy, Inventory Management, Prescription Fulfillment, Patient Care, Regulatory Compliance, Training, Technical Knowledge, Safety Procedures, Active Listening
Specialization
Candidates must comply with state board of pharmacy requirements, including age and education. A high school diploma or equivalent is required, and state-level licensure and national certification may vary.
Pharmacy Technician at CVS Health
Pinch, West Virginia, United States - Full Time
Skills Needed
Customer Service, Team Orientation, Communication Skills, Mathematical Reasoning, Problem Resolution, Attention To Detail, Empathy, Inventory Management, Flexibility, Compliance, Patient Care, Training, Safety, Technical Knowledge, Active Listening, Prescription Fulfillment
Specialization
Candidates must comply with state board of pharmacy requirements, including age and education. A high school diploma or equivalent is required, and state-level licensure and national certification may vary.
Social Worker, MSW, Trauma–Level 1 ED at SSM Health
St. Louis, Missouri, United States - Full Time
Skills Needed
Social Work, Crisis Intervention, Community Assistance, Collaboration, Assessment, Documentation, Liaison, Multi Disciplinary Teamwork
Specialization
A Master's degree in Social Work is required, but no prior experience is necessary. The role involves physical activities such as frequent reaching, sitting, and walking, along with the ability to communicate effectively.
Supply Chain Technician, Clinical at SSM Health
Saint Charles, Missouri, United States - Full Time
Skills Needed
Inventory Management, Patient Safety, Communication, Record Keeping, Supply Chain Management, Equipment Maintenance, Cycle Counts, Anesthesia Support
Specialization
No prior experience is required for this position. The role involves physical tasks such as lifting and carrying supplies, as well as maintaining accurate records and communication with staff.
Medical Assistant Certified/Registered at SSM Health
St. Louis, Missouri, United States - Full Time
Skills Needed
Patient Care, Vital Signs, Clerical Duties, Record Keeping, Scheduling, Materials Management, Communication, Documentation, Transcribing Orders, Teamwork, Safety Awareness, Clinical Duties, Patient Interaction, Environment Maintenance, Basic Life Support, Medical Assisting Certifications
Specialization
A high school diploma or equivalent is required, along with certification from an accredited medical assisting program. No prior experience is necessary for this position.
Senior Coordinator, Complaint & Appeals at CVS Health
Cacao, French Guiana, France -
Full Time

Start Date

Immediate

Expiry Date

11 Apr, 26

Salary

35.29

Posted On

11 Jan, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

No

Skills

Problem Solving, Decision Making, Compliance, Internal Audits, Data Analysis, Team Oversight, Training Development, Mentoring, Regulatory Requirements, Appeals Process, Grievances Management, Performance Metrics, Patient Interaction, Report Preparation, Policy Implementation

Industry

Hospitals and Health Care

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. Position Summary Prepares information and reports needed to address matters regarding complaints, appeals, and grievances. Carries out policies, procedures, and programs to ensure compliance with federal and/or state regulations. A Brief Overview Prepares information and reports needed to address matters regarding complaints, appeals, and grievances. Carries out policies, procedures, and programs to ensure compliance with federal and/or state regulations. What you will do Oversees team reviews, interpretations, and appeals filed by patients, escalating more complex issues and concerns to management for review and follow-up. Follows management-established procedures to validate consistent adherence to regulatory requirements, conducts internal audits, and addresses any identified compliance issues with the Complaint and Appeals policies and procedures. Conducts in-depth reviews of decisions and case files to determine if there are errors or anomalies in the application of law or evidence. Coordinates the drafting and progression of appeal decision letters, conducting detailed follow-up for timely and thorough follow-up and resolution. Measures and analyzes key performance indicators (KPIs) and metrics to evaluate the effectiveness and efficiency of the appeals and grievances process. Ensures all team members promptly and accurately respond to all patient billing questions and concerns. Develops and provides educational materials, training programs, and presentations to enhance understanding of the appeals and grievances process. Guides and mentors other colleagues in techniques, processes, and responsibilities for effectively handling member complaints and appeals. Facilitates training of junior-level staff to promote the development of departmental capabilities. Required Qualifications 2-5 years work experience Adept at problem solving and decision making skills Preferred Qualifications Please replace this section with the Preferred Job Qualifications Education High School Diploma Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $18.50 - $35.29 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: 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. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 01/25/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.
Responsibilities
Oversees team reviews and interpretations of complaints and appeals, escalating complex issues to management. Conducts audits and ensures compliance with regulations while coordinating the drafting of appeal decision letters.
Senior Coordinator, Complaint & Appeals at CVS Health
Cacao, French Guiana, France - Full Time
Skills Needed
Problem Solving, Decision Making, Compliance, Internal Audits, Data Analysis, Team Oversight, Training Development, Mentoring, Regulatory Requirements, Appeals Process, Grievances Management, Performance Metrics, Patient Interaction, Report Preparation, Policy Implementation
Specialization
Candidates should have 2-5 years of work experience and be adept at problem solving and decision making. A high school diploma is required for this position.
Experience Required
Minimum 2 year(s)
Executive Director, Regulatory Affairs at CVS Health
São Paulo, São Paulo, Brazil - Full Time
Skills Needed
Pharmacy, Healthcare, Regulatory Affairs, Communication Skills, Organizational Skills, Problem Solving Skills, Executive Presence, Business Judgment, Interpersonal Skills, Mentoring, Collaboration, Analytical Skills, Advocacy, Compliance, Leadership, Strategic Planning
Specialization
Candidates must possess a Pharmacy Degree and have over 8 years of experience in pharmacy and healthcare, particularly in regulatory laws. Strong communication skills and the ability to influence decision-making are essential.
Experience Required
Minimum 10 year(s)
Advanced Pharmacy Technician Back End (IV Infusion), Omnicare (Overnight) F at CVS Health
Town "n" Country, Florida, United States - Full Time
Skills Needed
Pharmacy Technician, Medication Fulfillment, Regulatory Compliance, Order Fulfillment, Packaging, Dispensing, Inventory Management, Customer Service, Team Coordination, Stock Rotation, Delivery Coordination, Compounding, Narcotics Management, Iv Infusion, Long Term Care, Quality Assurance
Specialization
Candidates must be certified or licensed pharmacy technicians with at least one year of experience. Preferred qualifications include experience in long-term care and PTCB National Certification.
Experience Required
Minimum 2 year(s)
Cashier at SSM Health
Oklahoma City, Oklahoma, United States - Full Time
Skills Needed
Cash Handling, Customer Service, Cash Register Operation, Payment Processing, Balancing Cash Receipts, Stocking Merchandise, Organizing Checkout Area, Data Entry
Specialization
No prior experience is required for this position. Physical requirements include frequent lifting and movement, as well as the ability to communicate effectively.
RN-Charge Nurse, Surgery (WO) at SSM Health
St. Louis, Missouri, United States - Full Time
Skills Needed
Leadership, Patient Care, Staff Management, Collaboration, Performance Evaluation, Patient Assessment, Quality Outcomes, Complaint Management, Training, Development, Communication, Safety, Nursing, Surgery, Education, Monitoring
Specialization
Candidates must be graduates of an accredited nursing school and have at least one year of registered nurse experience. Physical requirements include constant standing and walking, as well as frequent lifting and communication.
Medical Assistant at CVS Health
Indianapolis, Indiana, United States - Full Time
Skills Needed
Medical Assistant Certification, Patient Care, Vital Signs, Screenings, Medication Reviews, Telephonic Support, Vaccinations, Point Of Care Tests, Electronic Medical Record, Computer Skills, Problem Solving, Communication Skills, Customer Service, Attention To Detail, Flexibility, Team Collaboration
Specialization
Candidates must have state or national certification or graduation from an accredited medical assistant course, along with at least one year of experience. CPR or BLS certification and electronic medical record experience are also required.
Experience Required
Minimum 2 year(s)
Dentist at PDS Health
Snohomish, Washington, United States - Full Time
Skills Needed
N/A
Specialization
Candidates should have a dental degree and relevant licensure. Experience in a clinical setting is preferred.
Per Diem - Anesthesiology at UVA Health
, Virginia, United States - Full Time
Skills Needed
Anesthesiology, Patient Management, Medical Procedures, Health Assessments, Diagnostic Studies, Emergency Therapy, Medication Ordering, Consultation Requests, Patient Education, Quality Standards, Professional Development, Team Collaboration, Documentation, Cpt Coding, Icd Coding, Continuing Education
Specialization
Candidates must be graduates of an accredited medical school with an MD or DO degree and have completed an accredited residency in their chosen specialty. Board certification is required, and an unrestricted license to practice in Virginia must be maintained.
Shift Supervisor at CVS Health
, , United States - Full Time
Skills Needed
Management, Customer Service, Communication, Supervision, Analytical Skills, Deductive Reasoning, Computer Skills, Problem Solving, Team Leadership, Retail Experience, Merchandising, Inventory Management, Conflict Resolution, Time Management, Flexibility, Customer Relations
Specialization
Candidates should possess deductive reasoning, analytical, and computer skills, along with advanced communication and supervision abilities. A flexible schedule is required, including early morning, overnight, and weekend shifts.
Shift Supervisor at CVS Health
Falls Church, Virginia, United States - Full Time
Skills Needed
Management, Customer Service, Communication, Supervision, Analytical Skills, Deductive Reasoning, Computer Skills, Problem Solving, Team Leadership, Retail Experience, Merchandising, Inventory Management, Conflict Resolution, Time Management, Flexibility, Customer Relations
Specialization
Candidates should possess deductive reasoning, analytical, and computer skills, along with advanced communication and supervision abilities. Retail supervisory experience is preferred, and a high school diploma is preferred but not required.
Scheduler 40 hours at SSM Health
Monroe, Wisconsin, United States - Full Time
Skills Needed
Scheduling, Data Entry, Patient Services, Communication, Compliance, Documentation, Referral Coordination, Customer Service
Specialization
A high school diploma or GED is required, or 10 years of work experience. No prior experience is necessary for this position.
JANITORIAL at NEW Health
Suncrest, Washington, United States - Full Time
Skills Needed
Cleaning Equipment, Sanitization, Dusting, Trash Collection, Floor Maintenance, Infection Control, Attention To Detail, Time Management
Specialization
A high school diploma or GED is required, along with previous janitorial experience preferred. Knowledge of cleaning equipment and chemicals is necessary, and the role may require working evenings and weekends.
Respiratory Therapist at SSM Health
Oklahoma City, Oklahoma, United States - Full Time
Skills Needed
Patient Assessment, Respiratory Care, Patient Education, Equipment Maintenance, Emergency Response, Medication Administration, Care Plan Development, Monitoring Patient Condition
Specialization
An Associate's degree in Respiratory Care or equivalent experience is required, with no prior experience necessary. Candidates must hold relevant certifications such as BLS HCP and RRT, depending on the state of work location.
RN Cardiac Med Surg PRN at SSM Health
Fond du Lac, Wisconsin, United States - Full Time
Skills Needed
Compassion, Patient Care, Nursing Practice, Assessment Skills, Communication, Leadership, Collaboration, Education, Advocacy, Holistic Care, Cultural Sensitivity, Evidence Based Practice, Teamwork, Critical Thinking, Problem Solving
Specialization
Graduate of an accredited school of nursing is required, with no prior experience necessary. Candidates must hold a valid RN license and BLS certification.
Store Manager in Training at CVS Health
, , United States - Full Time
Skills Needed
Communication, Customer Care, Merchandising Strategies, Inventory Management, Leadership, Team Engagement, Sales Growth, Profitability Management
Specialization
Candidates are expected to have a high school diploma or GED, with a bachelor's degree preferred. Retail management experience or experience as a CVS Supervisor is also required.
Pharmacy Technician at CVS Health
San Diego, California, United States - Full Time
Skills Needed
Customer Service, Communication Skills, Mathematical Reasoning, Problem Resolution, Attention To Detail, Team Orientation, Flexibility, Empathy, Inventory Management, Prescription Fulfillment, Patient Care, Regulatory Compliance, Training, Technical Knowledge, Safety Procedures, Active Listening
Specialization
Candidates must comply with state board of pharmacy requirements, including age and education. A high school diploma or equivalent is required, and state-level licensure and national certification may vary.
Pharmacy Technician at CVS Health
Pinch, West Virginia, United States - Full Time
Skills Needed
Customer Service, Team Orientation, Communication Skills, Mathematical Reasoning, Problem Resolution, Attention To Detail, Empathy, Inventory Management, Flexibility, Compliance, Patient Care, Training, Safety, Technical Knowledge, Active Listening, Prescription Fulfillment
Specialization
Candidates must comply with state board of pharmacy requirements, including age and education. A high school diploma or equivalent is required, and state-level licensure and national certification may vary.
Social Worker, MSW, Trauma–Level 1 ED at SSM Health
St. Louis, Missouri, United States - Full Time
Skills Needed
Social Work, Crisis Intervention, Community Assistance, Collaboration, Assessment, Documentation, Liaison, Multi Disciplinary Teamwork
Specialization
A Master's degree in Social Work is required, but no prior experience is necessary. The role involves physical activities such as frequent reaching, sitting, and walking, along with the ability to communicate effectively.
Supply Chain Technician, Clinical at SSM Health
Saint Charles, Missouri, United States - Full Time
Skills Needed
Inventory Management, Patient Safety, Communication, Record Keeping, Supply Chain Management, Equipment Maintenance, Cycle Counts, Anesthesia Support
Specialization
No prior experience is required for this position. The role involves physical tasks such as lifting and carrying supplies, as well as maintaining accurate records and communication with staff.
Medical Assistant Certified/Registered at SSM Health
St. Louis, Missouri, United States - Full Time
Skills Needed
Patient Care, Vital Signs, Clerical Duties, Record Keeping, Scheduling, Materials Management, Communication, Documentation, Transcribing Orders, Teamwork, Safety Awareness, Clinical Duties, Patient Interaction, Environment Maintenance, Basic Life Support, Medical Assisting Certifications
Specialization
A high school diploma or equivalent is required, along with certification from an accredited medical assisting program. No prior experience is necessary for this position.