Complaint & Appeals Coordinator - Fully Remote

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position Summary

Responsible for managing to resolution of Fast Track Appeals for Medicare products, which may contain multiple issues and, may require coordination of responses from multiple business units and outside entities. Ensure timely, customer focused response to Medicare Fast Track Appeal requests. Identify trends and emerging issues and report and recommend solutions.Research incoming Medicare Fast Track appeals to identify if appropriate for unit based upon published business responsibilities. Identify correct resource and reroute inappropriate work items that do not meet appeal criteria. Identify and research all components within Fast Track appeals for all products and services.

Triage incomplete components of complaints/appeals to appropriate subject matter expert within another business unit(s) for resolution response content to be included in final resolution response.

Responsible for coordination of all components of Fast Track appeals including all required communication to member/provider for final resolution and closure.

Serve as a technical resource to colleagues on letter content, state or federal regulatory language, triaging

of complaint/appeal issues, and similar situations requiring a higher level of expertise.

Identifies trends and emerging issues and reports on and gives input on potential solutions. Follow up to assure Fast Track appeal is handled within established timeframe to meet company and regulatory requirements.

Act as single point of contact for Fast Track appeals on behalf of members or providers, as assigned.Must meet timeliness for Fast Track Appeals.Schedule:

Sunday-Thursday hours 9:00am-6:30pm EST in their time zoneHours of Operation:

Sunday- Saturday (7 days a week)

8 A.M. EST to 8 P.M. EST including weekends and holidays.Required Qualifications

• 1+ years' experience in Medicare
• At least 1+ years in one of the following areas: claim platforms, products, and benefits; patient management; product or contract drafting; compliance and regulatory analysis; special investigations; provider relations; customer service or audit experience.
• Experience in research and analysis of utilization management systems.
• Proficient in computer use, including Microsoft Word and exposure to Excel.

• 1+ years of Knowledge in Word, Excel, MHK, GPS, QuickBase applications, Teams, CMS Guidelines for Fast Track Appeals.

• High school Diploma/ GED required
• Associate Degree preferred

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.