Senior Coordinator, Complaint Appeals Operations
Employment Information
Job Description
Senior Coordinator managing complex appeal scenarios for CVS Health across multiple products. Ensures resolution through collaboration and research within various departments.
Responsibilities:
- Responsible for managing to resolution appeal scenarios for all products
- Develop into a subject matter expert by providing training, coaching, or responding to complex issues
- Research and resolves incoming electronic appeals
- Identify and reroute inappropriate work items
- Assemble all data used in making denial determinations
- Research standard plan design
- Coordinates efforts both internally and across departments
- Identifies trends and emerging issues and reports on potential solutions
- Deliver internal quality reviews
- Respond to Executive complaints and appeals as assigned
Requirements:
- 1-2 years Medicare part C Appeals experience
- Experience in reading or researching benefit language in SPDs or COCs
- Experience in research and analysis of claim processing a plus
- Demonstrated ability to handle multiple assignments competently, accurately and efficiently
- Excellent verbal and written communication skills
- Excellent customer service skills
- Experience documenting workflows and reengineering efforts
Benefits:
- Affordable medical plan options
- 401(k) plan (including matching company contributions)
- Employee stock purchase plan
- No-cost programs including wellness screenings
- Tobacco cessation and weight management programs
- Confidential counseling and financial coaching
- Paid time off
- Flexible work schedules
- Family leave
- Dependent care resources
- Colleague assistance programs
- Tuition assistance
- Retiree medical access
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