Medicaid Appeals & Grievance Operations Lead

4004 Aetna Medicaid Administrators; Louisiana (MO); On-site; USD 47,000 - 92,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a risk management professional to oversee day-to-day appeals, complaints and grievances handling across products, ensuring timely, customer-focused responses and adherence to federal/state requirements.

The role requires evaluating trends, coordinating with multiple units, and leading a team to meet financial, operational and quality objectives in a fast-paced environment.

Qualifications

• Excellent verbal and written communication skills.
• Solid project management skills.
• Experience documenting workflows and reengineering efforts.

Responsibilities

• Manages team's productivity and resources, communicates productivity expectations and balances workload to achieve customer satisfaction through prompt/accurate handling of customer concerns.
• Serves as a content model expert and mentor to team regarding policies and procedures, regulatory and accreditation requirements.
• Manages to performance measures and standards for quality service and cost effectiveness and coaches the team/individuals to take appropriate action.
• Participation in the staff selection process using clearly defined requirements in terms of education, experience, technical and performance skills.
• Build strong functional teams through formal training, diverse assignments, coaching, mentoring and other developmental techniques.

Skills

Communication skills

Project management

Customer service

Documentation

Education

Bachelor's degree or equivalent experience

Job description

CVS Health is seeking a risk management professional to oversee day-to-day appeals, complaints and grievances handling across products, ensuring timely, customer-focused responses and adherence to federal/state requirements.

The role requires evaluating trends, coordinating with multiple units, and leading a team to meet financial, operational and quality objectives in a fast-paced environment.