Coordinator, Complaint & Appeals

$35,360 - $65,104/Yr

CVS Health - Phoenix, AZ

Full-time - Entry Level

Phoenix, AZ

Health and Personal Care Retailers

About the position

The position is responsible for managing and resolving complaints and appeals related to various health care products. This role requires a customer-focused approach to ensure timely responses and involves coordinating with multiple business units. The individual will also identify trends and emerging issues, reporting and recommending solutions to enhance service delivery.

Responsibilities

• Manage complaint and appeal scenarios for all products, ensuring resolution and customer satisfaction.
• Coordinate responses from multiple business units to address complaints and appeals effectively.
• Identify trends and emerging issues in complaints and appeals, reporting findings and recommending solutions.
• Ensure timely and customer-focused responses to all complaints and appeals.

Requirements

• 1 year of experience with HMO and Traditional claim platforms, products, and benefits.
• Experience in patient management, product compliance, regulatory analysis, special investigations, provider relations, customer service, or audit.
• Ability to read and research benefit language in Summary Plan Descriptions (SPDs) or Certificates of Coverage (COCs).

Nice-to-haves

• Medicare experience
• Claims experience
• Experience in research and analysis of claim processing.

Benefits

• Medical, dental, and vision benefits
• 401(k) retirement savings plan
• Employee Stock Purchase Plan
• Fully-paid term life insurance
• Short-term and long-term disability benefits
• Well-being programs
• Education assistance
• Free development courses
• CVS store discount
• Paid Time Off (PTO)
• Paid holidays