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CVS Health is a leading healthcare company operating CVS Specialty, CVS Pharmacy, CVS MinuteClinic, and CVS Caremark. In 2018, CVS combined forces with healthca
Senior Coordinator, Complaint & Appeals
Location
Michigan
Posted
2 days ago
Salary
$18 - $35 / hour
Seniority
Senior
Job Description
Senior Coordinator, Complaint & Appeals
CVS Health
• Responsible for Oversight of that that investigates and resolution of appeals scenarios for all products • Ensure timely, customer focused response to appeals • Identify trends and emerging issues and report and recommend solutions • Independently coaches others on appeals ensuring compliance with Federal and/or State regulations • Manage control and trend inventory, independently investigate, adapts to changes or revise policy to resolve the most escalated cases • Responsible for serving as the point of contact for the appeal if there is an inquiry from leadership, compliance and State regulators • Understand and adapt to departmental process and policies • Research incoming electronic appeals, complaints and grievance to identify if appropriate for unit based upon published business responsibilities
Job Requirements
- At least 2+ years in one of the following areas: claim platforms, products, and benefits; patient management; product or contract drafting; compliance and regulatory analysis; special investigations; provider relations; customer service or audit experience
- Some Medicare and/or Medicaid knowledge
- Experience in reading or researching benefit language
- Ability to work in fast paced, high volume environment
- Excellent organizational skills to handle high inventory which aids in meeting or exceeding metrics
- Solution driven and can handle complex issues with accuracy
Benefits
- medical, dental, and vision coverage
- paid time off
- retirement savings options
- wellness programs
- other resources, based on eligibility
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