Senior Manager – Complaint & Appeals

Job not on LinkedIn

🔥 2 minutes ago

🇺🇸 United States – Remote

💵 $67.9k - $149.3k / year

⏰ Full Time

🟠 Senior

👔 Manager

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.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

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

• Develop and manage a team addressing complaints and appeals • Ensure compliance with federal and/or state regulations • Develop policies, procedures, and programs for regulatory compliance • Create audit tools to validate 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 business requirements for complaints and appeals system applications • Approve systems monitoring appeals-case timeliness and end-to-end workflows • Communicate with internal, external, and cross-functional partners regarding provider appeals handling • Collaborate with Compliance, Legal, Project Management, IT, Staff Development, and other departments • Ensure 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 • Award target in the company’s 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