Manages teams productivity and resources, communicates productivity expectations and balances workload to achieve customer satisfaction through prompt/accurate handling of customer concerns. Manages a team of non-clinical personnel.

Serves as a content model expert and mentor team in regard to Aetna's policies and procedures, regulatory and accreditation requirements.

Manages to performance measures and standards for quality service and cost effectiveness and coaches team/individuals to take appropriate action. Select staff using clearly defined requirements in terms of education, experience, technical and performance skills. build strong functional teams through formal training, diverse assignments, coaching, mentoring and other developmental techniques.

Assesses developmental needs and collaborates with others to identify and implement actin plans that support the development of high performing teams and individuals. Ensures work of team meets federal and state requirements and quality measures, with respect to letter content and turnaround times for Appeal handling

Holds individual/team accountable for results; recognize/reward as appropriate. Lead change efforts while managing transitions within a team. Identifies trends involving non-clinical and clinical issues and reports on and recommends solutions.

Additional duties assigned; Work environment includes typical office conditions. Sedentary work involving significant periods of sitting, talking, hearing, and keying. Work requires visual acuity to perform close inspection of written and computer generated documents as well as a PC monitor.Preferred Qualifications

Experience in Medicare Appeal research, analysis of pre-service appeals. Have clear understanding of CMS requirements and guidelines. Ability to perform root cause analysis, identity trends and provide solid solutions, helping to prevent negative metric impact.

Education

Bachelor's degree or 5 years equivalent work experience in Healthcare, Project Management, Audit and system design.Pay Range

The typical pay range for this role is:$82,940.00 - $182,549.40

This 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. This position also includes an award target in the company's equity award program.

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: 01/18/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.