Remote Senior Appeals & Compliance Coordinator

CVS Pharmacy; Kentucky; Remote; USD 25,000 - 48,000; Full time

Job summary

CVS Health is seeking a remote role focused on the fair, compliant resolution of patient complaints, appeals and grievances. You will drive process excellence, safeguard regulatory compliance, and improve the patient experience.

Join a dynamic team with 2–5 years of healthcare/compliance background, working full-time with 40 hours weekly. The position offers a comprehensive benefits package and a competitive hourly pay range.

Qualifications

• 2–5 years of relevant experience in healthcare, insurance, or compliance.
• 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

Problem solving

Attention to detail

Communication

Decision making

Education

High school diploma or equivalent

Job description

CVS Health is seeking a remote role focused on the fair, compliant resolution of patient complaints, appeals and grievances. You will drive process excellence, safeguard regulatory compliance, and improve the patient experience.

Join a dynamic team with 2–5 years of healthcare/compliance background, working full-time with 40 hours weekly. The position offers a comprehensive benefits package and a competitive hourly pay range.