The primary role of the Complaint and Appeals Sr. Coordinator is to manage to resolution 3rd Party Provider standard, independent, external review request and providing office support needed to ensure that business objectives are met. This support may include performing administrative and general office duties such as file audits, triage correspondence, mail distribution, and managing incoming telephone calls.

The Complaint and Appeals Sr. Coordinator for the National External Review Unit will:
• Research and investigate external review requests to determine eligibility against established criteria & regulatory requirements.
• Case preparation for submission to external vendors.
• Research incoming electronic correspondence to identify if appropriate for unit based upon published business responsibilities.
• Identify correct resource and reroute inappropriate work items that do not meet external review criteria.
• Open, sorts, and distributes mail.
• Operates scanning equipment to record source documents
• Scan US/UPS/FedEx mail to unit's email address
• Data Entry information in unit's QuickBase.
• Answer unit's toll-free line
• Respond & provide information on external review inquiries.
• Manage fax operations for unit.Required Qualifications
Must be able to work independently and collaboratively with internal departments (Network & Patient management, Claims, Customer Service, and Customer Resolution Team) and engage in frequent direct interaction with providers and vendors as needed. The successful candidate should be proficient with the utilization of Aetna standard office technology tools in day-to-day work, as well as the internal clinical management systems, (Complaints & Appeals Tracking System (CATS), Aetna Total View System (ATV), e.Publishing, MedCompass, Guided Personal Services (GPS), and Plan Sponsor Toolkit as well as delegated entities clinical systems.

Required Qualifications

Knowledge of appeals process/appeals experience.Education

High School or GED. An equivalent combination of education and experience may be sufficient.Pay Range

The typical pay range for this role is:$18.50 - $42.35This 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.

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: 03/03/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.