Sr Coordinator, Complaints & Appeals Operations

CVS Health; Hartford (CT); On-site; USD 25,000 - 54,000; Full time

Job summary

CVS Health in Hartford, CT is seeking a dedicated CMCA Appeals Processor to support daily processing of appeals. You will prepare determination letters, intake expedited requests, update the CATS system, and assist with panel hearings, working with Medical Directors, Nurses and Providers to ensure timely, compliant resolutions.

The role requires strong medical terminology knowledge, clear written and verbal communication, multi-tasking ability, and proficiency with Microsoft Office.

Qualifications

• Familiar with Medical Terminology.
• Strong written and verbal communication.
• Ability to multi-task.
• Proficient in basic computer skills including Microsoft Office Suite.

Responsibilities

• Process appeals determinations letters and intake expedited requests.
• Update systems and complete reporting as necessary.
• Support the panel hearing process and coordinate with Medical Directors, Nurses and Providers.
• Triage faxes and move cases in the Complaints and Appeals Tracking System (CATS).
• Ensure work is completed in compliance with turnaround times and regulatory standards.

Skills

Medical Terminology

Written & Verbal Communication

Multi-tasking

Microsoft Office Suite

Education

High School Diploma

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.

Position Summary

This position supports the daily processing of appeals in the Commercial Member Clinical Appeals (CMCA). Job functions include but not limited to, completing appeals determination letters, intake and launching of expedited requests, verbal expedited notifications/determinations, updating systems, completing reporting as necessary, supporting the panel hearing process, working collaboratively with clinical support staff (Medical Directors, Nurses, Providers, etc.), triage of faxes, and movement of cases in the Complaints and Appeals Tracking System (CATS). All work is to be handled in compliance of turnaround times and regulatory standards.

Required Qualifications

• Familiar with Medical Terminology
• Strong written and verbal communication
• Ability to multi-task
• Proficient in basic computer skills including Microsoft Office Suite

Preferred Qualifications

• Knowledge of appeals process/appeals experience
• Prior experience working in a medical setting

Education

High School Diploma

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$18.50 - $38.82

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.

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.

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: 09/30/2026

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