Appeals & Projects Manager - Team Leadership & Compliance

CVS Health; Boston (MA); On-site; USD 54,000 - 159,000; Full time

Benefits offered by this job

Health, dental, and vision

Paid time off

Retirement savings

Job summary

CVS Health in the United States is seeking an Appeals team leader to build and guide a high-performing staff, ensuring processes meet regulatory and accreditation standards. You will validate project effectiveness using data, lead meetings, and drive continuous improvement across the appeals function.

The role requires years of supervisory experience, strong communication and analytic skills, and collaboration across teams to deliver compliant, efficient outcomes in a full-time capacity.

Qualifications

• Minimum 3+ years Appeals background and experience.
• Proficient in Microsoft Word, Excel and PowerPoint.
• Knowledge of Appeals job aids and workflows.
• Strong communication skills with feedback ability.
• Excellent time management abilities.
• At least 2+ years of supervisory experience.
• Ability to collaborate across multiple teams.
• Strong analytical focus on accuracy and 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

Appeals experience

Microsoft Office

Appeals workflows

Communication skills

Time management

Supervisory experience

Cross-team collaboration

Analytical skills

Education

High school diploma

Bachelor's degree or equivalent

Job description

CVS Health in the United States is seeking an Appeals team leader to build and guide a high-performing staff, ensuring processes meet regulatory and accreditation standards. You will validate project effectiveness using data, lead meetings, and drive continuous improvement across the appeals function.

The role requires years of supervisory experience, strong communication and analytic skills, and collaboration across teams to deliver compliant, efficient outcomes in a full-time capacity.