Sr Coordinator, Complaints & Appeals Operations

CVS Health; Hartford (CT); On-site; USD 25,000 - 53,000; Full time

Job summary

CVS Health is seeking an Appeals Processor to support the Commercial Member Clinical Appeals (CMCA) workflow in Hartford, CT. This full-time role handles daily processing of appeals determinations, intake of expedited requests, and system updates.

You will collaborate with Medical Directors, nurses, and providers, maintain timely turnaround and regulatory compliance, and contribute to reporting and panel hearing preparation.

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 and intake expedited requests.
• Update systems and generate reports as necessary.
• Support panel hearing process and triage faxes.
• Coordinate with clinical support staff (Medical Directors, Nurses, Providers).

Skills

Medical terminology

Written communication

Verbal communication

Multi-tasking

MS Office

Education

High School Diploma

Tools

Microsoft Office Suite

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 (https://learn.bswift.com/cvshealth-mainland) .

We anticipate the application window for this opening will close on: 10/31/2026

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

CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran — committed to diversity in the workplace.