Remote Complaints & Appeals Coordinator - Patient Experience

4062 Aetna Resources, LLC; Kentucky; Hybrid; USD 38,000 - 73,000; 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 seeking a skilled health compliance professional to remotely resolve patient complaints, appeals, and grievances. You will analyze cases, draft decisions, and monitor regulatory adherence while driving process improvements and patient experience.

Join a collaborative team focused on accuracy, timely resolutions, and safeguarding federal and state regulations, with opportunities for growth within a leading health company.

Qualifications

• 2-5 years of relevant experience (healthcare, insurance, or compliance preferred)
• Strong analytical thinking and problem-solving skills
• Attention to detail with the ability to interpret policies and regulations
• Excellent communication and decision-making abilities
• High school diploma or equivalent

Responsibilities

• Review and manage patient complaints, appeals, and grievances, escalating complex cases as needed
• Conduct in-depth case analysis to identify errors, inconsistencies, or compliance gaps
• Coordinate and draft appeal decision letters, ensuring timely and accurate resolution
• Perform audits and monitor compliance with federal and state regulations
• Analyze KPIs to improve team performance and operational efficiency
• Support patient billing inquiries with accurate, responsive service
• Train, mentor, and guide team members on best practices and processes

Skills

Analytical thinking

Attention to detail

Communication skills

Decision-making abilities

Education

High school diploma or equivalent

Job description

CVS Health is seeking a skilled health compliance professional to remotely resolve patient complaints, appeals, and grievances. You will analyze cases, draft decisions, and monitor regulatory adherence while driving process improvements and patient experience.

Join a collaborative team focused on accuracy, timely resolutions, and safeguarding federal and state regulations, with opportunities for growth within a leading health company.