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CVS Health · 1 day ago

Senior Coordinator, Complaint & Appeals

Austin, TX

Full-time

Onsite

Mid, Senior Level

$18.50/hr - $35.29/hr

2+ years exp

CVS Health is the nation’s leading health solutions company, dedicated to transforming health care for millions of Americans. The Senior Coordinator, Complaint & Appeals is responsible for overseeing the review process of complaints and appeals, ensuring compliance with regulations, and providing training and support to team members.

Health CareMedicalPharmaceuticalRetailSales

Responsibilities

Oversees team reviews, interpretations, and appeals filed by patients, escalating more complex issues and concerns to management for review and follow-up

Follows management-established procedures to validate consistent adherence to regulatory requirements, conducts internal audits, and addresses any identified compliance issues with the Complaint and Appeals policies and procedures

Conducts in-depth reviews of decisions and case files to determine if there are errors or anomalies in the application of law or evidence

Coordinates the drafting and progression of appeal decision letters, conducting detailed follow-up for timely and thorough follow-up and resolution

Measures and analyzes key performance indicators (KPIs) and metrics to evaluate the effectiveness and efficiency of the appeals and grievances process

Ensures all team members promptly and accurately respond to all patient billing questions and concerns

Develops and provides educational materials, training programs, and presentations to enhance understanding of the appeals and grievances process

Guides and mentors other colleagues in techniques, processes, and responsibilities for effectively handling member complaints and appeals

Facilitates training of junior-level staff to promote the development of departmental capabilities

Qualification

Problem solvingDecision makingCompliance knowledgeReport preparationTraining development

Required

2-5 years work experience

Adept at problem solving and decision making skills

Benefits

Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.