Senior Appeals Operations Specialist

CVS Health; Hartford (CT); On-site; USD 25,000 - 54,000; Full time

Job summary

CVS Health in Hartford, CT is seeking a dedicated CMCA Appeals Processor to support daily processing of appeals. You will prepare determination letters, intake expedited requests, update the CATS system, and assist with panel hearings, working with Medical Directors, Nurses and Providers to ensure timely, compliant resolutions.

The role requires strong medical terminology knowledge, clear written and verbal communication, multi-tasking ability, and proficiency with Microsoft Office.

Qualifications

• Familiar with Medical Terminology.
• Strong written and verbal communication.
• Ability to multi-task.
• Proficient in basic computer skills including Microsoft Office Suite.

Responsibilities

• Process appeals determinations letters and intake expedited requests.
• Update systems and complete reporting as necessary.
• Support the panel hearing process and coordinate with Medical Directors, Nurses and Providers.
• Triage faxes and move cases in the Complaints and Appeals Tracking System (CATS).
• Ensure work is completed in compliance with turnaround times and regulatory standards.

Skills

Medical Terminology

Written & Verbal Communication

Multi-tasking

Microsoft Office Suite

Education

High School Diploma

Job description

CVS Health in Hartford, CT is seeking a dedicated CMCA Appeals Processor to support daily processing of appeals. You will prepare determination letters, intake expedited requests, update the CATS system, and assist with panel hearings, working with Medical Directors, Nurses and Providers to ensure timely, compliant resolutions.

The role requires strong medical terminology knowledge, clear written and verbal communication, multi-tasking ability, and proficiency with Microsoft Office.