Complaint And Appeals Coordinator - Fully Remote

Lensa; Tallahassee (FL); Remote; USD 60,000 - 80,000; Full time

Job summary

An established industry player is seeking a Complaint and Appeals Coordinator to manage complaint resolution for various products. This fully remote role involves coordinating responses from multiple business units and ensuring a customer-focused approach. Ideal candidates will have experience with HMO and traditional claims, along with strong customer service skills. Join a dedicated team committed to transforming health care and making a positive impact on consumers' lives. This position offers competitive pay and comprehensive benefits, making it a great opportunity for those looking to advance their careers in health solutions.

Benefits

401(k) plan with company matching

Affordable medical plan options

Employee stock purchase plan

Wellness screenings

Confidential counseling

Tuition assistance

Flexible work schedules

Paid time off

Family leave

Dependent care resources

Qualifications

• 1 year experience in claims platforms and patient management.
• Experience with compliance and regulatory analysis.

Responsibilities

• Manage resolution of complaint and appeal scenarios.
• Ensure timely, customer-focused responses to complaints.

Skills

HMO and Traditional claim platforms

Patient management

Product compliance and regulatory analysis

Customer service

Audit experience

Education

High School or Equivalent

Job description

Complaint And Appeals Coordinator - Fully Remote

Complaint And Appeals Coordinator - Fully Remote

2 days ago Be among the first 25 applicants

Lensa is the leading career site for job seekers at every stage of their career. Our client, CVS Health, is seeking professionals. Apply via Lensa today!

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

Responsible for managing to resolution complaint/appeal scenarios for all products, which may contain multiple issues and may require coordination of responses from multiple business units. Ensure timely, customer focused response to complaints/appeals. Identify trends and emerging issues and report and recommend solutions.

This position can be anywhere in the United States.

Required Qualifications

• 1 year experience that includes both HMO and Traditional claim platforms, products, and benefits, patient management, product, compliance and regulatory analysis, special investigations, provider relations, customer service or audit experience.
  
  

Preferred Qualifications

• Medicare experience
• Claims experience
• Experience in reading or researching benefit language in Summary Plan Description (SPDs) or Certificate of Coverage (COCs)
• Experience in research and analysis of claim processing a plus.
  
  

Education

• High School or Equivalent
  
  

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The Typical Pay Range For This Role Is

$17.00 - $25.65

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.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great Benefits For Great People

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• 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.
  
  

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 05/05/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  IT Services and IT Consulting

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