Senior Coordinator Complaint & Appeals

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:
This is a work at home opportunity for candidates located in any state.

At Aetna, a CVS Health Company, we are joined in a common purpose, helping people on their path to better health. We are working to transform healthcare through innovations that make quality care more accessible, easier to use, less expensive and patient focused.

Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive work environment. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience.As a Complaints Tracking Module (CTM) Senior Coordinator, you will be part of the Medicare Complaints Tracking Module (CTM) Team, responsible for researching and resolving Medicare complaints received via the Centers for Medicaid and Medicare Services (CMS).

In this role, you will manage a queue of Medicare complaints. These complaints can include various issues ranging from claims that are adjudicated incorrectly to rude customer service.

You will be responsible for identifying the Medicare beneficiary's complaint, researching Plan systems to identify the issue, partnering with other business departments to correct any potential issue, determining root cause, and bringing final resolution to the complaint. Resolution responses must be timely and include beneficiary focused solutions in both written and oral format. This is not a call center position, but you will be required to make outbound calls to both beneficiaries and providers to resolve their complaint. Department metrics are in place that include, but not limited to quality and productivity. Time management is very important in order to maintain compliancy with Medicare.

• Excellent communication skills, both verbal and oral
• Excellent problem-solving skills and critical thinking ability
• Time management skills
• Experience handling customer calls and elevated issues
• Ability to document resolution in written communication to beneficiaries in a professional and easy to understand manner
• Experience troubleshooting complex customer problems
• Attention to detail
• Ability to work across various departments as necessary to establish the root cause and resolution of the issue
• Ability to toggle between multiple applications
• Ability to manage complaint caseload effectively
• Ability to work flexible hours, some weekends and holidays.
• Overtime may be required during busy times of year

• Experience with Microsoft Office Suite, Word, Outlook and Excel
• General Medicare knowledge/experience
• Prior experience with complaints and/or Center for Medicare and Medicaid Services (CMS)
• Medical/RX claim processing knowledge
• Bachelors Degree

• 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.