Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.Position Summary:
The Appeals Manager will serve as a content expert to his/her team regarding policies and procedures, regulatory and accreditation requirements. This role will be responsible for managing performance and resource requirements for auditing needs. Responsibilities include but are not limited to:
Want more jobs like this?
Get jobs in Topeka, KS delivered to your inbox every week.
- Build and maintain a solid team through training, coaching and developing staff
- Validate effectiveness of the appeals team through universe data validation.
- Facilitate and present at meetings within the Appeals team and during audits.
- Establish and maintain in collaboration with the business, consistent processes defining the overview and audit readiness of appeals to help remain compliant with regulatory and accreditation requirements
- Identify trends and recommends/acts on solutions.
- Report capabilities related to audit requests and universe submissions.
Required Qualifications
- 3+ years Appeals or Claims background
- 2+ years of supervisory or leadership experience
- Microsoft Office experience
- Knowledge of Appeals job aids/workflows
- Strong Communication skills - ability to provide and receive feedback
- Excellent time management skills
- Ability to work collaboratively across teams
- Strong analytical skills focusing on accuracy and attention to details
- 2+ years Audit experience
- Knowledge of CMS guidance
- DG system experience
- Product knowledge and experience with Appeals and Regulatory Requirements
Bachelor's degree or equivalent experience highly preferred Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:$54,300.00 - $145,860.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit Benefits | CVS HealthWe anticipate the application window for this opening will close on: 03/31/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.