CVS Health

Bringing our heart to every moment of your health.

Senior Coordinator, Complaint Appeals Operations

OperationsOperationsFull TimeRemoteTeam 10,001+Since 1963H1B No SponsorCompany SiteLinkedIn

Location

Florida

Posted

13 days ago

Salary

$18 - $35 / hour

High School1 yr expEnglish

Job Description

• 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 as appropriate as a “single-point-of-contact” based on type of appeal • Can identify and reroute inappropriate work items that do not meet complaint/appeal criteria • Assemble all data used in making denial determinations • Research standard plan design, certification of coverage and potential contractual deviations • Review a clinical determination and understand rationale for decision • Coordinates efforts both internally and across departments to successfully resolve claims research

Job 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 for all colleagues 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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