Medicaid Appeals & Grievance Associate Manager

CVS Health

. Coordinate effective resolution of member and/or provider/practitioner appeals, complaints, and grievances .

Posted 9/21/2026full-timeRemote • Louisiana • United StatesJuniorMid-Level💰 $46,988 - $91,800 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in managing member and provider appeals, complaints, and grievances while ensuring compliance with federal and state regulations. Proven ability to lead teams, enhance productivity, and implement effective policies and procedures.

Highest-signal resume keywords

Appeals ManagementProject ManagementCustomer ServiceRegulatory ComplianceTeam Leadership

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Benefit Language ResearchWorkflow DocumentationClaims ProcessingPerformance MeasurementQuality Assurance

Soft Skills

Verbal CommunicationWritten CommunicationCoachingMentoringProblem Solving

Industry Keywords

Aetna PoliciesAccreditation RequirementsProvider RelationsPatient ManagementContract Drafting

About the role

Key responsibilities & impact

Coordinate effective resolution of member and/or provider/practitioner appeals, complaints, and grievances
Manage staff day to day to ensure effective and timely resolution across all products
Coordinate responses from multiple business units for complex issues
Implement Aetna's appeals, complaints, and grievances policies and procedures
Identify trends and issues; report on and recommend solutions
Meet financial, operational, and quality objectives of the unit
Manage team productivity, resources, workload, and customer satisfaction
Serve as a content model expert and mentor on policies, procedures, regulatory, and accreditation requirements
Manage performance measures and standards; coach team members
Participate in staff selection using education, experience, technical, and performance requirements
Build functional teams through training, assignments, coaching, and mentoring
Assess developmental needs and implement team and individual development plans
Ensure work meets federal and state requirements and quality measures for letter content and turnaround time
Hold individuals and teams accountable for results and recognize or reward performance
Lead change efforts and manage team transitions
Research and route incoming electronic appeals, complaints, and grievances
Research plan design or certification of coverage to assess benefit or administrative denials
Research claim processing logic, eligibility data, and billing/payment status
Identify and research all components of member or provider/practitioner appeals, complaints, and grievances
Carry a modified case load and perform additional assigned duties

Requirements

What you’ll need

Must live in Louisiana
Experience in reading or researching benefit language
Excellent verbal and written communication skills
Solid project management skills
Excellent customer service skills
Experience documenting workflows and reengineering efforts
Bachelor's degree or equivalent experience
Ability to work 40 hours per week
Preferred: 1–2 years of experience including claim platforms, products, and benefits; patient management; product or contract drafting; compliance and regulatory analysis; special investigations; provider relations; customer service; or audit experience

Benefits

Comp & perks

Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Comprehensive benefits package supporting physical, emotional, and financial well-being
CVS Health bonus, commission or short-term incentive program eligibility