Senior Coordinator, Appeals Management

CVS Health Corporation; United States; Remote; USD 50,000 - 70,000; Full time

Job summary

A leading healthcare company is looking for a Senior Coordinator, Complaint and Appeals to oversee investigations and manage escalated cases. The role requires at least 2 years of experience and knowledge in claims and compliance. This position is remote and demands excellent organizational skills in a fast-paced environment.

Qualifications

• At least 2+ years of experience in claims, patient management, compliance, or related fields.
• Some knowledge of Medicare and/or Medicaid is preferred.
• Experience in researching benefit language.

Responsibilities

• Oversee investigations and resolutions of appeals.
• Coach team members on compliance with regulations.
• Research and translate policies for senior leadership.

Skills

Claims management

Patient management

Compliance knowledge

Research skills

Ability to work in a fast-paced environment

Education

High School diploma or GED

Job description

A company is looking for a Senior Coordinator, Complaint and Appeals (Remote, PST).

Key Responsibilities

• Oversee investigations and resolutions of appeals, ensuring timely and customer-focused responses
• Coach team members on compliance with federal and state regulations while managing escalated cases
• Research and translate policies into clear responses for senior leadership regarding escalated cases

Required Qualifications

• At least 2+ years of experience in claims, patient management, compliance, or related fields
• Some knowledge of Medicare and/or Medicaid is preferred
• Experience in researching benefit language
• Ability to work in a fast-paced, high-volume environment
• High School diploma or GED required