[Hiring] Senior Manager - Complaint & Appeals @CVS Health

Role Description

Coordinate effective resolution of member or provider/practitioner appeals, complaints and grievances.

• Establish and maintain consistent policies and procedures for the administration and resolution of appeals, complaints and grievances.
• Ensure compliance with legislative, regulatory and accreditation requirements for all plans in the region.
• Maintain infrastructure for ease of use and consistent resolution responses accessible to all operational resolution teams and business units.

Qualifications

• 1-3 years supervisory experience.
• 3-5 years A&G experience.

Requirements

• Manages and teams productivity and resources within the region.
• Communicates productivity expectations and balances workload to achieve customer satisfaction.
• Manages a team of clinical and/or non-clinical personnel.
• Serves as a content model expert and mentor regarding Aetna's policies and procedures.
• Manages to performance measures and standards for quality service and cost effectiveness.
• Selects staff using clearly defined requirements in terms of education, experience, technical and performance skills.
• Builds strong functional teams through formal training, diverse assignments, coaching, mentoring, and other developmental techniques.
• Assesses developmental needs and implements action plans for high performing individuals and teams.
• Ensures team work meets federal and state requirements and quality measures.
• Utilizes the National tracking tool for reporting consistency and trend analysis.
• Holds individuals/team accountable for results; recognizes/rewards as appropriate.
• Leads change efforts while managing transitions within a team.
• Identifies trends involving non-clinical & clinical issues and recommends solutions.
• Additional duties as assigned.

Preferred Qualifications

• Strong analytical skills focusing on accuracy and attention to detail.
• Sound judgement.
• Product knowledge and experience with appeals, complaints and grievances and Regulatory Requirements.
• Knowledge of clinical terminology, regulatory and accreditation requirements.
• Excellent verbal and written communication skills.
• Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word.

Education

• Bachelor's degree or 5 years equivalent work experience in Healthcare, Project Management, Audit, Systems Design.

Pay Range

The typical pay range for this role is: $67,900.00 - $149,328.00. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.

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.