[Hiring] Senior Coordinator, Complaint & Appeals @CVS Health

Role Description

Join our team and play a key role in ensuring fair, compliant resolution of patient complaints, appeals, and grievances. You’ll help drive process excellence, safeguard regulatory compliance, and improve the overall patient experience.

• Review and manage patient complaints, appeals, and grievances, escalating complex cases as needed
• Conduct in-depth case analysis to identify errors, inconsistencies, or compliance gaps
• Coordinate and draft appeal decision letters, ensuring timely and accurate resolution
• Perform audits and monitor compliance with federal and state regulations
• Analyze KPIs to improve team performance and operational efficiency
• Support patient billing inquiries with accurate, responsive service
• Train, mentor, and guide team members on best practices and processes

Qualifications

• 2–5 years of relevant experience (healthcare, insurance, or compliance preferred)
• Strong analytical thinking and problem-solving skills
• Attention to detail with the ability to interpret policies and regulations
• Excellent communication and decision-making abilities
• High school diploma or equivalent

Requirements

• Anticipated Weekly Hours: 40
• Time Type: Full time
• Pay Range: $18.50 - $35.29

Benefits

• Comprehensive benefits package designed to support physical, emotional, and financial well-being
• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs and other resources, based on eligibility