Strategic Appeals & Projects Manager

CVS Health; Annapolis (MD); Hybrid; USD 54,000 - 159,000; Full time

Job summary

CVS Health is hiring for a role focused on leading the Appeals team, developing staff, and ensuring compliant processes. The candidate will validate project effectiveness using data, facilitate team meetings, and drive action plans for high performance.

Responsibilities include project management, trend identification, audit reporting, and collaboration with business units to maintain readiness and compliance with regulatory standards.

Qualifications

• 3+ years of Appeals experience.
• Proficient in Microsoft Office.
• Knowledge of Appeals job aids/workflows.
• Strong communication with feedback skills.
• Excellent time management abilities.
• 2+ years supervising staff.
• Collaborative across teams.
• Analytical with focus on accuracy.

Responsibilities

• Build and maintain a solid team through training, coaching and developing staff.
• Validate effectiveness of the different projects managed by appeals team through universe data validation.
• Facilitate and present at meetings within the Appeals team.
• Establish and maintain in collaboration with the business, consistent processes defining the overview and readiness of appeals to help remain compliant with regulatory and accreditation requirements.
• Assess developmental needs and collaborate with others to identify and implement action plans that support the development of high performing teams and individuals.
• Manage projects and identify trends and recommends/acts on solutions.
• Report capabilities related to audit requests and universe submissions.

Skills

Appeals background

MS Office

Job aids/workflows

Communication skills

Time management

Supervisory experience

Cross-team collaboration

Analytical skills

Education

High school diploma or higher education

Bachelor's degree or equivalent experience

Tools

QuickBase

CMS guidance

Appeals / Medicare knowledge

Job description

CVS Health is hiring for a role focused on leading the Appeals team, developing staff, and ensuring compliant processes. The candidate will validate project effectiveness using data, facilitate team meetings, and drive action plans for high performance.

Responsibilities include project management, trend identification, audit reporting, and collaboration with business units to maintain readiness and compliance with regulatory standards.