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Posted: 10/20/2026Senior Manager – Complaint & Appeals
CVS HealthCore Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managing complaints and appeals within a regulatory framework, ensuring compliance with federal and state regulations while developing effective policies and procedures. Proven ability to lead teams, analyze training needs, and collaborate across departments to enhance operational efficiency and data integrity.
Highest-signal resume keywords
Managed Care ExperienceAppeal And Grievance ExperienceNCQA Audit ExperienceRegulatory ComplianceBudget Management
About the role
Key responsibilities & impact- Develop and manage a team addressing complaints and appeals
- Ensure compliance with federal and/or state regulations
- Develop policies, procedures, and programs for regulatory compliance
- Create audit tools to validate Complaint and Appeals data integrity, timeliness, and reporting accuracy
- Oversee daily operations, budget management, staff development, audit readiness, training, documentation, and procedures
- Follow up on compliance risks and develop mitigation strategies
- Establish business requirements for complaints and appeals system applications
- Approve systems monitoring appeals-case timeliness and end-to-end workflows
- Communicate with internal, external, and cross-functional partners regarding provider appeals handling
- Collaborate with Compliance, Legal, Project Management, IT, Staff Development, and other departments
- Ensure accountability for quality, training, and production metrics
- Analyze training needs and develop resources
Requirements
What you’ll need- 3+ years experience in managed care
- 2+ years of Appeal and Grievance Experience
- NCQA or EQRO Audit experience
- Bachelor's degree preferred/specialized training/relevant professional qualification
Benefits
Comp & perks- CVS Health bonus, commission or short-term incentive program
- Award target in the company’s equity award program
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Policy DevelopmentAudit Tool CreationData Integrity AnalysisMitigation Strategy DevelopmentTraining Resource Development
Soft Skills
Team LeadershipCommunicationCollaborationAccountability
Tools & Technologies
Complaints And Appeals System Applications
Industry Keywords
Federal RegulationsState RegulationsQuality MetricsTraining Needs Analysis