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

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.