Quality Appeal Coordinator (Meritain Health)

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
The Quality Appeal Coordinator coordinates reviews and evaluations for complaints and appeals received by the organization. This includes denied claims, coverage issues, medical necessity, service quality, or other concerns expressed by patients, providers, or other stakeholders. This person applies in-depth knowledge of subject matter and independently coaches others on matters regarding complaints and appeals.In this role, you will:

• Handle quality checks for the appeals team, in order to ensure overall accuracy.
• Regularly trend quality errors for both the team and individuals.
• Hold coaching session for the team, in order to address any commonly occurring errors.
• Answer any and all questions related to appeals, as needed and designated.
• Assist in keeping relevant workflows up to date.

• 2-4 years of experience in appeals.
• Knowledge of Microsoft Office products (Word, Excel, PowerPoint, Outlook).

• Prior experience working with claims.
• Prior experience in health insurance.
• Prior experience in compliance or auditing.
• Basic awareness of problem solving and decision-making skills.

• High school diploma or GED.

• 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.