Complaint And Appeals Coordinator - Fully Remote

Hispanic Alliance for Career Enhancement; Tallahassee (FL); Remote; USD 60,000 - 80,000; Full time

Job summary

Join a leading health solutions company dedicated to transforming healthcare for millions of Americans. In this role, you will manage complaint and appeal resolutions, ensuring customer-focused responses and identifying trends. This position offers the flexibility to work from anywhere in the United States, supporting a collaborative environment where your contributions truly matter. With competitive pay and comprehensive benefits, this opportunity is perfect for those passionate about making a difference in healthcare.

Benefits

Affordable medical plan options

401(k) plan with matching contributions

Employee stock purchase plan

Wellness screenings

Tobacco cessation programs

Weight management programs

Confidential counseling

Financial coaching

Tuition assistance

Flexible work schedules

Qualifications

• 1 year experience with HMO and Traditional claims.
• Experience in patient management and regulatory analysis.

Responsibilities

• Manage resolution of complaints/appeals for all products.
• Ensure timely, customer-focused responses to complaints.

Skills

HMO and Traditional claim platforms

Patient management

Regulatory analysis

Customer service

Audit experience

Education

High School or Equivalent

Job description

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.