Senior Coordinator, Complaint and Appeals

CVS Health Careers

. Review and investigate member complaints, appeals, and grievances in accordance with established policies and procedures .

Posted 11/5/2026full-timeRemote • Ohio • United StatesSenior💰 $19 - $35 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Medicaid Complaint and Appeals processes, with strong analytical and problem-solving capabilities. Proficient in managing multiple priorities while ensuring compliance with federal and state regulations.

Highest-signal resume keywords

Medicaid Complaint & Appeals ExperienceAnalytical SkillsWritten Communication SkillsMicrosoft Office ProficiencyHealthcare Industry Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Case AnalysisDocumentation ManagementIssue ResolutionProcess ImprovementQuality Assurance

Soft Skills

Problem-SolvingDecision-MakingTime ManagementCollaborationVerbal Communication

Industry Keywords

HealthcareInsuranceClaims ProcessingCustomer ServiceRegulatory Compliance

About the role

Key responsibilities & impact

Review and investigate member complaints, appeals, and grievances in accordance with established policies and procedures
Analyze case information, supporting documentation, and benefit information to determine appropriate case outcomes
Prepare accurate and timely written correspondence related to complaint and appeal determinations
Ensure cases are processed within established quality, productivity, and turnaround time standards
Research and resolve complex issues by collaborating with internal business partners and applicable stakeholders
Maintain accurate and complete case documentation in applicable systems
Identify potential trends or process concerns and escalate issues as appropriate
Participate in departmental projects, training, and process improvement initiatives
Support compliance with federal and state regulations and internal policies governing complaint and appeal activities

Requirements

What you’ll need

5+ years of work experience with Medicaid Complaint & Appeals
Strong analytical, problem-solving, and decision-making skills
Excellent written and verbal communication skills
Ability to manage multiple priorities and adhere to established deadlines
Proficiency in Microsoft Office applications
High school diploma or equivalent required
Experience in healthcare, insurance, claims, customer service, complaints and appeals, or related operations preferred
Experience researching and resolving complex customer or member issues preferred
Knowledge of health plan benefits, claims, and appeals processes preferred

Benefits

Comp & perks

Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being, based on eligibility