Medicaid Appeals Operations Manager

CVS Health Corporation; United States; Remote; USD 47,000 - 92,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health Corporation in the United States is seeking a Risk Management professional to lead the day-to-day resolution of member and provider appeals, complaints and grievances across products, ensuring timely, customer-focused responses.

You will manage staff productivity, coach for policy compliance, and drive improvements to meet financial, operational and quality objectives while benefiting from CVS Health’s comprehensive pay and benefits package.

Qualifications

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

Responsibilities

• Coordinate effective resolution of member and/or provider appeals, complaints and grievances.
• Lead day-to-day management of staff to ensure timely, customer-focused responses.
• Ensure adherence to policies for appeals, complaints and grievances and identify trends.
• Mentor team on policies, regulatory and accreditation requirements.
• Participate in staff selection with defined requirements.

Skills

Benefit language understanding

Verbal communication

Written communication

Project management

Customer service

Education

Bachelor's degree or equivalent experience

Job description

CVS Health Corporation in the United States is seeking a Risk Management professional to lead the day-to-day resolution of member and provider appeals, complaints and grievances across products, ensuring timely, customer-focused responses.

You will manage staff productivity, coach for policy compliance, and drive improvements to meet financial, operational and quality objectives while benefiting from CVS Health’s comprehensive pay and benefits package.