Senior Manager, Compliance & Appeals Operations

CVS Health; Indianapolis (IN); In loco; USD 68.000 - 149.000; Tempo pieno

Vantaggi offerti da questo lavoro

Bonus eligibility

Equity incentives

Descrizione del lavoro

CVS Health is seeking a dedicated Manager to lead a team focused on complaints and appeals, ensuring adherence to federal and state regulations. The role directs policy development and programs aligned with government agency requirements.

You will build audit tools, manage daily operations, monitor data integrity and timeliness, and collaborate across Compliance, Legal, IT, and Operations to drive quality and customer satisfaction.

Competenze

• 3+ years experience in managed care.
• 2+ years of Appeal and Grievance Experience.
• NCQA or EQRO Audit experience.
• Bachelor’s degree preferred or specialized training

Mansioni

• Create audit tools to validate Complaint and Appeals data integrity and timeliness for reporting.
• Oversee day-to-day operations of teams, budgets, staff development, and documentation.
• Address compliance risks and develop mitigation strategies.
• Establish business requirements for system applications supporting complaints and appeals.
• Approve systems monitoring timeliness of appeals casework end-to-end.
• Coordinate with internal/external partners for timely provider appeals review.
• Collaborate with Compliance, Legal, IT, and other departments on operational initiatives.
• Ensure staff accountability to quality, training, and production metrics.
• Analyze training needs to strengthen competitive advantage.

Conoscenze

Regulatory compliance

Audit experience

Formazione

Bachelor’s degree

Descrizione del lavoro

CVS Health is seeking a dedicated Manager to lead a team focused on complaints and appeals, ensuring adherence to federal and state regulations. The role directs policy development and programs aligned with government agency requirements.

You will build audit tools, manage daily operations, monitor data integrity and timeliness, and collaborate across Compliance, Legal, IT, and Operations to drive quality and customer satisfaction.