Senior Manager - Complaint & Appeals

CVS Health; Indiana; Hybrid; USD 68,000 - 149,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Senior Manager to lead a team addressing complaints and appeals, ensuring compliance with applicable federal and state regulations. You will develop policies and programs that align with government agency requirements and CVS Health standards.

The role focuses on building audit tools, overseeing operations, coordinating with Compliance, Legal, IT, and business partners, and driving improvements to ensure timely reviews, data integrity, and high customer satisfaction.

Qualifications

• Minimum 3+ years of managed care experience.
• 2+ years of Appeal and Grievance experience.
• NCQA or EQRO audit experience.

Responsibilities

• Create audit tools to validate Complaint and Appeals data integrity, timeliness, and accuracy of data outputs for all Complaint and Appeals reporting.
• Oversee day-to-day operations of high-performing teams, including budget, staff development, audit readiness, training, and documentation.
• Develop mitigation strategies to address compliance risks and ensure adherence to regulatory requirements.
• Set business requirements for systems supporting complaints and appeals based on regulatory changes.
• Approve systems for monitoring timeliness of appeals cases end-to-end and ensure required workflows.

Skills

Managed care experience

Appeal & Grievance experience

Audit experience (NCQA/EQRO)

Education

Bachelor's degree preferred

Job description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger– helping to simplify health care one person, one family and one community at a time.

Job Description Summary

Develops and manages a team to address matters regarding complaints and appeals, ensuring compliance with federal and/or state regulations. Leads the development of policies, procedures, and programs to ensure compliance with policies of all applicable federal and/or state government agencies.

What you will do

• Create audit tools to validate Complaint and Appeals data integrity, timeliness, and accuracy of data outputs for all Complaint and Appeals reporting.
• Control day-to-day operational oversight of highly performing teams, budget management, staff development, audit readiness, staff training, documentation and execution, and procedure documentation.
• Follow up on compliance risks and works to develop mitigation strategies to address identified issues to ensure compliance with these regulations.
• Establish business requirements for system applications to support complaints and appeals based on business needs or change in regulatory requirements.
• Approve systems for monitoring the timeliness of appeals cases from end-to-end, ensuring workflow procedures are met to achieve company goals.
• Communicate with both internal, external, and cross-functional partners to ensure the ability to serve appropriate and timely review of provider appeals handling.
• Collaborate with Compliance, Legal, Project Management, IT, Staff development, and various other internal departments to support operational initiatives.
• Allocate accountability for ensuring staff is held accountable to quality, training, and production metrics to ensure a high level of customer satisfaction and loyalty.
• Analyze training needs to develop appropriate resources and successfully enhance the company's competitive advantage in the industry.

For this role you will need

• Minimum Requirements 3+ years experience in managed care
• 2+ years of Appeal and Grievance Experience
• NCQA or EQRO Audit experience
• Education Bachelor's degree preferred/specialized training/relevant professional qualification.

Pay Range

The typical pay range for this role is: $67,900.00 - $149,328.00. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families.

• The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 10/29/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.