Project Manager, Complaints & Appeals

CVS Health; Connecticut; Hybrid; USD 54,000 - 159,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Job summary

CVS Health is seeking a capable Appeals Team Lead to build and mentor a strong staff, validate project effectiveness with data, and present during Appeals team meetings. You will help ensure readiness of appeals for regulatory and accreditation standards while coordinating development plans for high-performing teams and individuals.

The role emphasizes cross-team collaboration, project management, and data-driven decisions, with a focus on accuracy and regulatory compliance.

Qualifications

• 3+ years Appeals background required.
• Proficient with Microsoft Office applications.
• Knowledge of appeals job aids/workflows.
• Strong communication skills with the ability to provide and receive feedback.
• Excellent time management skills.
• 2+ years of supervisory experience.
• Ability to work collaboratively across teams.
• Strong analytical skills focusing on accuracy and detail.

Responsibilities

• Build and maintain a solid team through training, coaching and developing staff.
• Validate effectiveness of projects managed by appeals team through universe data validation.
• Facilitate and present at meetings within the Appeals team.
• Establish and maintain processes defining the overview and readiness of appeals to help remain compliant with regulatory and accreditation requirements.
• Assess developmental needs and identify action plans to support development of high performing teams and individuals.
• Manage projects, identify trends and recommend/act on solutions.
• Report capabilities related to audit requests and universe submissions.

Skills

Appeals background

Microsoft Office

Job aids/workflows

Strong communication

Time management

Supervisory experience

Collaboration across teams

Analytical skills

Project management

QuickBase

Training or leadership

CMS guidance

Medicare regulatory knowledge

Education

High school diploma or higher

Bachelor’s degree or equivalent experience

Tools

QuickBase

Job description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Job Summary

Build and maintain a solid team through training, coaching and developing staff Validate effectiveness of the different projects managed by appeals team through universe data validation. Facilitate and present at meetings within the Appeals team. Establish and maintain in collaboration with the business, consistent processes defining the overview and readiness of appeals to help remain compliant with regulatory and accreditation requirements. Assess developmental needs and collaborate with others to identify and implement action plans that support the development of high performing teams and individuals. Manage projects and identify trends and recommends/acts on solutions. Report capabilities related to audit requests and universe submissions.

Required Qualifications

• 3+ years Appeals background
• Microsoft Office experience
• Knowledge of Appeals job aids/workflows
• Strong Communication skills - ability to provide and receive feedback
• Excellent time management skills
• 2+ years of supervisory experience
• Ability to work collaboratively across teams
• Strong analytical skills focusing on accuracy and attention to details

Preferred Qualifications

• 2+ years Project Management experience
• QuickBase experience
• 2+ years training or leadership experience
• Knowledge of CMS guidance
• Product knowledge and experience with Appeals and Medicare Regulatory Requirements
• Appeals and MHK knowledge/experience

Education

• High school diploma or higher education
• Bachelor's degree or equivalent experience

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is: $54,300.00 - $159,120.00 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. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Benefits

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments.

Application Deadline

We anticipate the application window for this opening will close on: 10/31/2026

Equal Opportunity Statement

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

Company Culture

Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.