Senior Appeals & Projects Manager

CVSHealth; Massachusetts; On-site; USD 54,000 - 159,000; Full time

Benefits offered by this job

Bonus program

Comprehensive benefits

Job summary

CVS Health, a leading health care company, seeks an Appeals supervisor to lead and develop the team responsible for appeals governance and outcomes. The role emphasizes collaboration across teams, training, and ensuring regulatory compliance with CMS guidance.

The position offers a competitive benefits package and the potential for bonus based on performance. Located in Massachusetts, it requires strong analytical and communication skills and prior supervisory experience.

Qualifications

• 3+ years Appeals background.
• Knowledge of Appeals job aids/workflows.
• 2+ years of supervisory experience.
• 2+ years training or leadership experience.

Responsibilities

• 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 processes with the business for readiness of appeals to stay compliant with regulatory requirements.
• Assess developmental needs and identify action plans to develop high performing teams and individuals.
• Manage projects and identify trends, recommending solutions.
• Report capabilities related to audit requests and universe submissions.

Skills

Communication skills

Time management

Analytical skills

Collaboration across teams

Supervisory experience

Education

High school diploma or higher

Bachelor's degree or equivalent experience

Tools

Microsoft Office

QuickBase

Job description

CVS Health, a leading health care company, seeks an Appeals supervisor to lead and develop the team responsible for appeals governance and outcomes. The role emphasizes collaboration across teams, training, and ensuring regulatory compliance with CMS guidance.

The position offers a competitive benefits package and the potential for bonus based on performance. Located in Massachusetts, it requires strong analytical and communication skills and prior supervisory experience.