Appeals Project Manager - Lead Teams & Compliance

CVS Health; Raleigh (NC); On-site; USD 54,000 - 159,000; Full time

Job summary

CVS Health in Raleigh, NC is seeking an Appeals Supervisor to lead a team through training, coaching and staff development, while ensuring compliant processes for appeals activity. This role involves validating project effectiveness and presenting findings to the team to drive improvements.

Responsibilities include establishing standard processes with business partners, overseeing audits and data submissions, and guiding staff to identify developmental needs.

Qualifications

• 3+ years in Appeals background.
• Microsoft Office experience.
• Knowledge of Appeals job aids/workflows.
• Strong communication skills with feedback ability.
• Excellent time management skills.
• 2+ years of supervisory experience.
• Ability to work collaboratively across teams.
• Strong analytical skills focusing on accuracy and detail.

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 consistent processes defining the overview and readiness of appeals to help remain compliant with regulatory and accreditation requirements.
• Assess developmental needs and identify action plans that support high performing teams and individuals.
• Manage projects and identify trends and recommend actions.
• Report capabilities related to audit requests and universe submissions.

Skills

Appeals background

Microsoft Office

Appeals workflows

Communication skills

Time management

Supervisory experience

Collaborative across teams

Analytical skills

Education

High school diploma or higher

Bachelor's degree or equivalent experience

Job description

CVS Health in Raleigh, NC is seeking an Appeals Supervisor to lead a team through training, coaching and staff development, while ensuring compliant processes for appeals activity. This role involves validating project effectiveness and presenting findings to the team to drive improvements.

Responsibilities include establishing standard processes with business partners, overseeing audits and data submissions, and guiding staff to identify developmental needs.