Senior Coordinator, Complaint Appeals

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🔥 1 hour ago

🥔 Idaho, Mississippi, +2 more states – Remote

🥔 Idaho – Remote 🎸 Mississippi – Remote 🔔 Pennsylvania – Remote 🤠 Texas – Remote

💵 $18 - $38 / hour

⏰ Full Time

🟠 Senior

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Provide support to the Supervisors by coaching, mentoring and training new staff • Oversight over inventory • Responsible for Oversight of that that investigates and resolution of appeals scenarios for all products, which may contain multiple issues and, may require coordination of responses from multiple business units • Ensure timely, customer focused response to appeals • Identify trends and emerging issues and report and recommend solutions • Independently coaches others on appeals ensuring compliance with Federal and/or State regulations • Manage control and trend inventory, independently investigate, adapts to changes or revise policy to resolve the most escalated cases coming from internal and external constituents for all products • Responsible for serving as the point of contact for the appeal if there is an inquiry from leadership, compliance and State regulators • Understand and adapt to departmental process and policies • Medicare knowledge is a plus • Fast Turn Around of inventory, collaboration with clinical team and management • Attention to detail is needed and must be able to maintain compliance turn-around times, with accurate case resolution or research • Remain a part of the solution by escalating issues that may impact compliance timeliness.

🎯 Requirements

• 2-4 years of experience in a Customer Service role • 2-4 years of Medicare and/or Medicaid knowledge • At least 2-4 years of experience that includes but is not limited to clinical and claim platforms, benefits and services • Compliance and regulatory knowledge; provider relations and customer service • Experience in reading or researching benefit language • Ability to work in fast paced environment • Excellent verbal and written communication skills • Excellent organizational skills to handle high inventory which aids in meeting or exceeding metrics • Solution driven and can handle complex issues with accuracy • Availability to work alternating weekends for oversight of analysts on alternate schedule

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • other resources, based on eligibility