Coordinator, Complaint & Appeals

CVS Health; Town of Woodstock (NY); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare provider is seeking a responsible individual to manage and resolve complaints and appeals in a fully remote position. The ideal candidate has at least one year of experience with claims platforms and a high school diploma. This role entails providing timely responses to customer complaints and identifying trends to improve processes. Competitive hourly rate offered.

Benefits

Affordable medical plans

401(k) plan with matching contributions

Flexible work schedules

Qualifications

• 1 year experience in claims processing.
• Experience with patient management and regulatory analysis.
• Ability to identify trends in complaints.

Responsibilities

• Manage and resolve complaint/appeal scenarios.
• Provide timely customer responses.
• Report and recommend solutions based on trends.

Skills

HMO and Traditional claim platforms experience

Patient management

Customer service

Education

High School Diploma or Equivalent

Job description

Overview

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.

Shift

Monday through Friday, 8:00am - 5:00pm Eastern Time

Location

WFH - This position can be anywhere in the United States but must be willing to work eastern time schedule.

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

Education

High School Diploma or Equivalent

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The Typical Pay Range For This Role Is $17.00 - $34.15

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.

Benefits

• 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: 10/10/2025

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