Senior Coordinator, Complaint and Appeals

Job not on LinkedIn

🔥 25 minutes ago

🏈 Ohio – Remote

🏈 Ohio – Remote

💵 $18 - $35 / hour

⏰ Full Time

🟠 Senior

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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CVS Health Careers

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛒 Retail

📦 Logistics

Healthcare • Retail • Logistics

CVS Health Careers is the recruitment and employer branding arm of CVS Health, showcasing job opportunities across the company's broad operations—pharmacy retail stores, pharmacy services, health care clinics, distribution warehouses, corporate functions and transportation. The careers site emphasizes purpose-driven work focused on improving access, affordability and quality of health care, and highlights a large workforce (300,000+ employees), inclusive culture, benefits, and hiring resources for applicants.

📋 Description

• Review and investigate member complaints, appeals, and grievances in accordance with established policies and procedures • Analyze case information, supporting documentation, and benefit information to determine appropriate case outcomes • Prepare accurate and timely written correspondence related to complaint and appeal determinations • Ensure cases are processed within established quality, productivity, and turnaround time standards • Research and resolve complex issues by collaborating with internal business partners and applicable stakeholders • Maintain accurate and complete case documentation in applicable systems • Identify potential trends or process concerns and escalate issues as appropriate • Participate in departmental projects, training, and process improvement initiatives • Support compliance with federal and state regulations and internal policies governing complaint and appeal activities

🎯 Requirements

• 5+ years of work experience with Medicaid Complaint & Appeals • Strong analytical, problem-solving, and decision-making skills • Excellent written and verbal communication skills • Ability to manage multiple priorities and adhere to established deadlines • Proficiency in Microsoft Office applications • High school diploma or equivalent required • Experience in healthcare, insurance, claims, customer service, complaints and appeals, or related operations preferred • Experience researching and resolving complex customer or member issues preferred • Knowledge of health plan benefits, claims, and appeals processes preferred

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being, based on eligibility

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