Remote Senior Appeals & Compliance Coordinator

CVS Health Corporation; Nevada (IA); Hybrid; USD 53,010,000 - 101,116,000; Full time

Job summary

CVS Health Corporation in the United States is seeking a Senior Coordinator for Complaint & Appeals. This remote, full-time role focuses on fair, compliant resolution of patient complaints, appeals, and grievances, with 40 hours per week.

You will review cases, draft decision letters, conduct audits for regulatory compliance, and mentor teammates while improving patient experience and KPI performance. The position offers a comprehensive benefits package and opportunities for growth; pay ranges

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.

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

Education

High school diploma or equivalent

Job description

CVS Health Corporation in the United States is seeking a Senior Coordinator for Complaint & Appeals. This remote, full-time role focuses on fair, compliant resolution of patient complaints, appeals, and grievances, with 40 hours per week.

You will review cases, draft decision letters, conduct audits for regulatory compliance, and mentor teammates while improving patient experience and KPI performance. The position offers a comprehensive benefits package and opportunities for growth; pay ranges