Senior Coordinator , Complaint and Appeals - must reside in Ohio

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
Prepares, researches, and evaluates information necessary to resolve member complaints, appeals, and grievances. Reviews case documentation, analyzes benefit and policy information, and ensures accurate, timely, and compliant case resolution in accordance with established procedures and regulatory requirements.

A Brief Overview

The Complaints & Appeals Analyst is responsible for reviewing, investigating, and resolving member complaints, appeals, and grievances. This role requires strong analytical and problem-solving skills to evaluate case information, research complex issues, and communicate clear and accurate determinations. The analyst works collaboratively with internal business partners to ensure cases are resolved accurately, timely, and in accordance with applicable policies and procedures.

What you will do

• Reviews and investigates member complaints, appeals, and grievances in accordance with established policies and procedures.
• Analyzes case information, supporting documentation, and benefit information to determine appropriate case outcomes.
• Prepares accurate and timely written correspondence related to complaint and appeal determinations.
• Ensures cases are processed within established quality, productivity, and turnaround time standards.
• Researches and resolves complex issues by collaborating with internal business partners and applicable stakeholders.
• Maintains accurate and complete case documentation in applicable systems.
• Identifies potential trends or process concerns and escalates issues as appropriate.
• Participates in departmental projects, training, and process improvement initiatives.
• Supports compliance with federal and state regulations and internal policies governing complaint and appeal activities.
  
  Required Qualifications
  • 5+ years of work experience with Medicaid Complaint & Appeals
  • Strong analytical, problem-solving, and decision-making skills.
  • Excellent written and verbal communication skills.
  • Ability to manage multiple priorities and adhere to established deadlines.
  • Proficiency in Microsoft Office applications.
    
    Preferred Qualifications
    Experience in healthcare, insurance, claims, customer service, complaints and appeals, or related operations.
  • Experience researching and resolving complex customer or member issues.
  • Knowledge of health plan benefits, claims, and appeals processes preferred.
    
    Education
    High school diploma or equivalent required.

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

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.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

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

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