Senior Coordinator Complaint & Appeals

rking 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.
Required Qualifications

• 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

Preferred Qualifications

• 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

Education:

High School DiplomaAnticipated Weekly Hours
40Time Type
Full timePay Range

The typical pay range for this role is:$18.50 - $42.35This 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 peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• 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.

For more information, visit https://jobs.cvshealth.com/us/en/benefitsWe anticipate the application window for this opening will close on: 08/25/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.