Senior Coordinator, Complaint & Appeals

This is a fully remote position, open to applicants in Nevada.

📋 Description

• Oversee and address patient complaints, appeals, and grievances, elevating complex cases when necessary.

• Execute comprehensive case evaluations to uncover errors, discrepancies, or gaps in compliance.

• Organize and prepare appeal decision letters, ensuring resolutions are both timely and precise.

• Conduct audits and track adherence to federal and state regulations.

• Assess KPIs to enhance team performance and operational effectiveness.

• Assist with patient billing inquiries by providing accurate and prompt service.

• Educate, mentor, and support team members on best practices and processes.

⛳️ Requirements

• 2–5 years of pertinent experience (preferably in healthcare, insurance, or compliance).

• Strong analytical and problem-solving capabilities.

• Keen attention to detail with the ability to understand policies and regulations.

• Exceptional communication and decision-making skills.

• High school diploma or its equivalent.

• Capacity to work 40 hours per week.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program in addition to base salary.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting the physical, emotional, and financial well-being of colleagues and their families.

• Opportunities for growth and development.

• A collaborative team environment.