Appeals Project Manager & Compliance Lead

CVS Health; Nashville (TN); On-site; USD 54,000 - 159,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a results-driven leader to build and mentor the Appeals team, driving training and development to foster high performance. You will validate project effectiveness using universe data and present findings in cross-functional meetings.

The role emphasizes establishing consistent processes with the business, ensuring regulatory and accreditation readiness while guiding teams to action plans and trend-driven improvements.

Qualifications

• 3+ years Appeals background
• Microsoft Office experience
• Knowledge of Appeals job aids/workflows
• Strong Communication skills - ability to provide and receive feedback
• Excellent time management skills
• 2+ years of supervisory experience
• Ability to work collaboratively across teams
• Strong analytical skills focusing on accuracy and attention to details

Responsibilities

• Build and maintain a solid team through training, coaching and developing staff
• Validate effectiveness of the different projects managed by appeals team through universe data validation.
• Facilitate and present at meetings within the Appeals team.
• Establish and maintain in collaboration with the business, consistent processes defining the overview and readiness of appeals to help remain compliant with regulatory and accreditation requirements.
• Assess developmental needs and collaborate with others to identify and implement action plans that support the development of high performing teams and individuals.
• Manage projects and identify trends and recommends/acts on solutions.
• Report capabilities related to audit requests and universe submissions.

Skills

Communication

Time management

Supervisory experience

Collaboration

Analytical thinking

Attention to detail

Education

High school diploma or higher

Bachelor's degree or equivalent experience

Tools

Microsoft Office

QuickBase

Job description

CVS Health is seeking a results-driven leader to build and mentor the Appeals team, driving training and development to foster high performance. You will validate project effectiveness using universe data and present findings in cross-functional meetings.

The role emphasizes establishing consistent processes with the business, ensuring regulatory and accreditation readiness while guiding teams to action plans and trend-driven improvements.