Complaint and Appeals Senior Coordinator

Clinical Careers Page(2 days ago)

TennesseeOnsiteFull TimeMedior$37,000 - $63,440Healthcare Compliance and Appeals

About this role

This role involves reviewing and processing appeals related to healthcare provider claims while ensuring compliance with regulatory standards. The Senior Ops Coordinator supports internal audits, drafts appeal decision letters, and serves as an expert on complex cases, contributing to the overall efficiency and accuracy of the appeals process.

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Required Skills

Regulatory Compliance
Appeals Processing
Internal Audits
Case Management
Healthcare Claims
Communication Skills
Software Proficiency
Healthcare Regulations
Mentoring
Research and Analysis

About Clinical Careers Page

cvshealth.com

CVS Health is America's leading health solutions company, providing integrated services across retail pharmacy (CVS Pharmacy), pharmacy benefits management (CVS Caremark), and health insurance (Aetna). The company offers pharmacy services, health plans, clinical care (including MinuteClinic), and health-and-wellness programs for consumers, employers, and government payers. By combining a large national retail footprint with claims processing, care management, and clinical services, CVS Health aims to coordinate care, lower costs, and improve health outcomes. Businesses and consumers use its solutions for medication management, plan administration, and in-person and virtual care.

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