Sr Appeal and Grievance Coordinator

Job description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary: ***Perfer live in New Jersey*** Coordinate effective resolution of member or provider/practitioner appeals. Responsible for managing to resolution of appeals, complaints and grievances scenarios for all products, which contain multiple issues and may require coordination of responses from multiple business units. Appeals are typically more complex and may require outreach and deviation from standard processes to complete. May have contact with outside plan sponsors or regulators. -Research and resolve incoming electronic appeals, complaints and grievances as appropriate as a “single-point-of-contact” based on type of case. -Can identify and reroute inappropriate work items that do not meet appeal, complaint and grievance criteria...