Senior Coordinator, Complaint Appeals Operations

CVS Health

Senior Coordinator managing appeal scenarios for multiple products at CVS Health. Ensuring resolution via training and coordinated responses across various departments.

Posted 5/5/2026full-timeRemote • Pennsylvania • 🇺🇸 United StatesSenior💰 $19 - $35 per hourWebsite

About the role

Key responsibilities & impact

Responsible for managing to resolution appeal scenarios for all products
Develop into a subject matter expert by providing training and coaching
Research and resolves incoming electronic appeals as appropriate
Identify and reroute inappropriate work items
Assemble all data used in making denial determinations
Research standard plan design and potential contractual deviations
Coordinates efforts both internally and across departments
Identifies trends and emerging issues and reports on potential solutions

Requirements

What you’ll need

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

Comp & perks

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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Medicare part C Appeals experienceresearch and analysis of claim processingreading benefit languagedocumenting workflowsreengineering efforts

Soft Skills

trainingcoachingcommunication skillscustomer service skillsability to handle multiple assignments