Senior Manager, Appeals & Complaints Operations

4004 Aetna Medicaid Administrators; Oklahoma; On-site; USD 68,000 - 149,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Other resources

Job summary

CVS Health is seeking a program-savvy leader in Oklahoma to coordinate the resolution of member and provider appeals, complaints, and grievances. You will develop and maintain policies in collaboration with business units, ensuring compliant resolution across plans in the region.

The role requires 1-3 years of supervisory experience and 3-5 years of A&G experience, with strong analytical and communication skills to drive quality service and regulatory compliance.

Qualifications

• Strong analytical skills focusing on accuracy and attention to detail.
• Excellent verbal and written communication skills.
• Additional duties as assigned; 1-3 years supervisory experience.
• 3-5 years A&G experience.

Responsibilities

• Coordinate effective resolution of member or provider appeals, complaints and grievances.
• Establish and maintain policies and procedures for administration and resolution of appeals, complaints and grievances.
• Ensure compliance with regulatory and accreditation requirements across plans in the region.

Skills

Analytical skills

Verbal communication

Written communication

Supervisory experience

Education

Bachelor's degree or 5 years equivalent experience in Healthcare/PM/Audit/Systems Design

Job description

CVS Health is seeking a program-savvy leader in Oklahoma to coordinate the resolution of member and provider appeals, complaints, and grievances. You will develop and maintain policies in collaboration with business units, ensuring compliant resolution across plans in the region.

The role requires 1-3 years of supervisory experience and 3-5 years of A&G experience, with strong analytical and communication skills to drive quality service and regulatory compliance.