Project Manager, Complaints & Appeals

About the role

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.

Job Summary:  

Build and maintain a solid team through training, coaching and developing staff 

Validate effectiveness of the different projects managed by appeals team through universe data validation. 

Facilitate and present at meetings within the Appeals team. 

Establish and maintain in collaboration with the business, consistent processes defining the overview and readiness of appeals to help remain compliant with regulatory and accreditation requirements. 

Assess developmental needs and collaborate with others to identify and implement action plans that support the development of high performing teams and individuals. 

Manage projects and identify trends and recommends/acts on solutions. 

Report capabilities related to audit requests and universe submissions. 

Required Qualifications 

3+ years Appeals background 

Microsoft Office experience 

Knowledge of Appeals job aids/workflows 

Strong Communication skills - ability to provide and receive feedback 

Excellent time management skills 

2+ years of supervisory experience 

Ability to work collaboratively across teams 

Strong analytical skills focusing on accuracy and attention to details 

Preferred Qualifications 

2+ years Project Management experience 

QuickBase experience 

2+ years training or leadership experience 

Knowledge of CMS guidance 

Product knowledge and experience with Appeals and Medicare Regulatory Requirements 

Appeals and MHK knowledge/experience 

Education  

High school diploma or higher education 

Bachelor's degree or equivalent experience

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.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 

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.