Coordinator, Complaint & Appeals - Customer Experience Expert

Join our team and make a difference in healthcare! We're seeking a highly skilled and customer-focused Coordinator, Complaint & Appeals to join our dynamic team. As a hybrid role, you'll have the flexibility to work from our remote office and home. This position offers a competitive salary and a comprehensive benefits package.

At CVS Health, we believe in Bringing our heart to every moment of your health. Our purpose guides our commitment to deliver enhanced human-centric healthcare for a rapidly changing world. We're looking for individuals who share our passion and want to make a positive impact.

Position Summary

As a Coordinator, Complaint & Appeals, you'll be responsible for managing complaint and appeal scenarios for all products, ensuring timely and customer-focused responses. You'll identify trends and emerging issues, reporting and recommending solutions to drive continuous improvement.

Key Responsibilities:

• Review and process appeals filed by participating providers
• Assist with adherence to regulatory requirements, conduct internal audits, and address compliance issues
• Draft and send appeal decision letters

Requirements:

• 1 year of experience in HMO and Traditional claim platforms, products, and benefits, patient management, product, compliance and regulatory analysis, special investigations, provider relations, customer service, or audit experience
• High School or Equivalent education

Preferred Qualifications:

• Medicare experience
• Claims experience
• Experience in reading or researching benefit language in Summary Plan Description (SPDs) or Certificate of Coverage (COCs)
• Experience in research and analysis of claim processing

What We Offer:

• Competitive salary: $17.00 - $28.46 per hour
• Comprehensive benefits package, including medical, dental, and vision benefits
• 401(k) retirement savings plan and Employee Stock Purchase Plan
• Fully-paid term life insurance plan and short-term and long-term disability benefits
• Paid Time Off (PTO) and paid holidays
• Opportunities for education assistance, free development courses, and CVS store discounts

If you're passionate about delivering exceptional customer experiences and driving positive change in healthcare, we want to hear from you! Apply now and join our team!