Medicaid Appeals & Grievances Leader

CVS Health; Baton Rouge (LA); 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

Wellness programs

Job summary

CVS Health is hiring for a Senior Risk Management professional in Baton Rouge to oversee day-to-day management of staff handling member and provider appeals, complaints and grievances across products. You will ensure timely, customer-focused responses and enforcement of CVS policies and regulatory requirements.

Responsibilities include coordinating multi-unit responses, driving performance through coaching, and identifying trends to improve outcomes.

Qualifications

• Experience reading or researching benefit language.
• Excellent verbal and written communication skills.
• Solid project management skills.
• Excellent customer service skills.
• Experience documenting workflows and reengineering efforts.

Responsibilities

• Coordinate effective resolution of member and/or provider/practitioner appeals, complaints and grievances.
• Lead and manage day-to-day operations of staff to ensure effective resolution of appeals, complaints and grievances.
• Ensure compliance with CVS Health policies and regulatory requirements.
• Identify trends and report insights; drive performance improvements.
• Collaborate with multiple business units to respond to appeals and grievances.

Education

Bachelor's degree or equivalent experience

Job description

CVS Health is hiring for a Senior Risk Management professional in Baton Rouge to oversee day-to-day management of staff handling member and provider appeals, complaints and grievances across products. You will ensure timely, customer-focused responses and enforcement of CVS policies and regulatory requirements.

Responsibilities include coordinating multi-unit responses, driving performance through coaching, and identifying trends to improve outcomes.