Senior Manager – Complaint & Appeals

Job not on LinkedIn

🔥 3 minutes ago

🇺🇸 United States – Remote

💵 $67.9k - $149.3k / year

⏰ Full Time

🟠 Senior

👔 Manager

👻 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.

Apply Now

Find Similar Remote Jobs

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

• Develop and manage a team addressing complaints and appeals • Ensure compliance with applicable federal and state regulations • Develop policies, procedures, and programs for regulatory compliance • Create audit tools validating Complaint and Appeals data integrity, timeliness, and reporting accuracy • Oversee daily operations, budget management, staff development, audit readiness, training, documentation, and procedures • Follow up on compliance risks and develop mitigation strategies • Establish system application requirements for complaints and appeals • Approve systems monitoring end-to-end appeals timeliness and workflow compliance • Coordinate timely provider appeals review with internal, external, and cross-functional partners • Collaborate with Compliance, Legal, Project Management, IT, Staff Development, and other departments • Ensure staff accountability for quality, training, and production metrics • Analyze training needs and develop resources

🎯 Requirements

• 3+ years experience in managed care • 2+ years of Appeal and Grievance Experience • NCQA or EQRO Audit experience • Bachelor's degree preferred/specialized training/relevant professional qualification

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program • Equity award program • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume