Senior Coordinator, Complaint & Appeals

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose‑driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate.

And we do it all with heart, each and every day.

Prepares information and reports needed to address matters regarding complaints, appeals, and grievances. Carries out policies, procedures, and programs to ensure compliance with federal and/or state regulations.

• Oversees team reviews, interpretations, and appeals filed by patients, escalating more complex issues and concerns to management for review and follow‑up.
• Follows management‑established procedures to validate consistent adherence to regulatory requirements, conducts internal audits, and addresses any identified compliance issues with the Complaint and Appeals policies and procedures.
• Conducts in‑depth reviews of decisions and case files to determine if there are errors or anomalies in the application of law or evidence.
• Coordinates the drafting and progression of appeal decision letters, conducting detailed follow‑up for timely and thorough follow‑up and resolution.
• Measures and analyzes key performance indicators (KPIs) and metrics to evaluate the effectiveness and efficiency of the appeals and grievances process.
• Ensures all team members promptly and accurately respond to all patient billing questions and concerns.
• Develops and provides educational materials, training programs, and presentations to enhance understanding of the appeals and grievances process.
• Guides and mentors other colleagues in techniques, processes, and responsibilities for effectively handling member complaints and appeals.
• Facilitates training of junior‑level staff to promote the development of departmental capabilities.

• 2-5 years work experience
• Adept at problem solving and decision making skills

High School Diploma

40

Full time

The typical pay range for this role is: $18.50 - $35.29.

We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

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We anticipate the application window for this opening will close on: 01/25/2026

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