Senior Coordinator - Complaint Appeals Operations

Yesterday

🇺🇸 United States – Remote

🌵 Arizona – Remote

Although this job is listed in Arizona, this company may be open to hiring remote in other states.

🔔 Pennsylvania – Remote

Although this job is listed in Pennsylvania, this company may be open to hiring remote in other states.

💵 $18 - $38 / hour

⏰ Full Time

🟠 Senior

⚙️ Operations

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CVS Health

WebsiteLinkedInAll Job Openings

Retail • Pharmacy Benefits Management • Health Insurance • Health Care • Pharmacy

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Description

• Responsible for managing resolution of appeal scenarios for all products. • Develop into a subject matter expert by providing training and responding to complex issues. • Research and resolve incoming electronic appeals. • Identify trends in misrouted work. • Review clinical determinations and ensure accuracy of denial determinations. • Educate team mates on complaints and appeals processes. • Coordinate efforts across departments for claim resolution. • Deliver internal quality reviews and provide support in audits and meetings.

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. • Strong knowledge of all case types including all specialty case types.

Benefits

• Full range of medical, dental, and vision benefits. • 401(k) retirement savings plan. • Employee Stock Purchase Plan. • Fully-paid term life insurance. • Short-term and long-term disability benefits. • Well-being programs. • Education assistance. • Free development courses. • CVS store discount. • Paid Time Off (PTO) and paid holidays.