Complaint And Appeals Coordinator - Fully Remote

CVS Health; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

An established industry player is seeking a Complaint and Appeals Coordinator to join their fully remote team. This role is pivotal in managing complaint and appeal scenarios, ensuring timely and customer-focused responses. The ideal candidate will have experience with HMO and Traditional claim platforms, patient management, and regulatory compliance. This position offers a comprehensive benefits package, including medical plans and flexible work schedules, making it an excellent opportunity for those passionate about transforming health care. If you're ready to make a difference, apply today!

Benefits

Affordable medical plans

401(k) with matching contributions

Employee stock purchase plan

No-cost wellness programs

Flexible work schedules

Paid time off

Tuition assistance

Qualifications

• 1+ years of experience in claims platforms and patient management.
• Experience with compliance, regulatory analysis, and customer service.

Responsibilities

• Manage complaint and appeal scenarios across multiple business units.
• Ensure timely, customer-focused responses to complaints and appeals.

Skills

HMO and Traditional claim platforms

Patient management

Compliance and regulatory analysis

Customer service

Claims processing

Education

High School diploma or equivalent

Job description

Complaint And Appeals Coordinator - Fully Remote

Pay 17.00 - 25.65 / hour

Location: Remote

Employment type: Full-Time

Job Description

• Req#: R0565836

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

This position can be located anywhere in the United States.

Required Qualifications

• At least 1 year of experience involving HMO and Traditional claim platforms, products, benefits, patient management, compliance and regulatory analysis, special investigations, provider relations, customer service, or audit experience.

Preferred Qualifications

• Medicare experience
• Claims processing experience
• Experience reading or researching benefit language in Summary Plan Descriptions (SPDs) or Certificates of Coverage (COCs)
• Research and analysis of claim processing is a plus

Education

• High School diploma or equivalent

Additional Details

Anticipated weekly hours: 40

Time type: Full-time

Pay Range

The typical pay range for this role is $17.00 - $25.65 per hour. The actual offer depends on experience, education, location, and other factors.

Benefits

We offer comprehensive benefits, including:

• Affordable medical plans, 401(k) with matching contributions, and employee stock purchase plan
• No-cost wellness programs, counseling, and financial coaching
• Flexible work schedules, paid time off, family leave, dependent care resources, tuition assistance, retiree medical access, and more

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

The application window closes on 05/05/2025. Qualified applicants with arrest or conviction records will be considered in accordance with laws.

About CVS Health

We share a purpose: helping people on their path to better health. Through health services, plans, and community pharmacists, we’re pioneering a new approach to total health—making quality care more affordable, accessible, and seamless.