Senior Complaints, Grievances, & Appeals Analyst

Senior Complaints, Grievances, & Appeals Analyst

Senior Complaints, Grievances, & Appeals Analyst

Cvs Health

Workday

Work At Home-Ohio

9 horas atrás

Nenhuma candidatura

Sobre

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 person will be responsible for curating, leading, and providing oversight of our proficiency program. This includes planning, executing, and supervising departmental projects to ensure they are completed within scope and aligned with organizational objectives. Functional Components Collaborating with account executives to resolve any member or plan sponsor complaints. Communicates professionally and empathetically with various members in response to their complaints. Works regularly within QuickBase, particularly as it relates to claims. Possesses a knowledge of plan sponsor nuances, performance guarantees, and placements, as it relates to various internal systems, in order to curate strong relationships with account executives. Leads program for proficiency, specifically related to behavioral health, RFL (Resources for Living), and provider services. Obtains any needed information for team to allow for a smooth and consistent functionality. Curates refresher courses for the team, in an effort to facilitate comfort and knowledge throughout the department. Collaborates cross-functionally with leaders and managers, specifically related to obtaining and applying quality measures. Supports various project management initiatives, related to organizational implementation within a non-clinical capacity. Proactively deals with any departmental ad hoc situations as needed. Required Qualifications 3-5 years of experience in behavioral health, including working with systems, processes, and key nuances. 3-5 years of experience in RFL (Resources for Living) or EAP (Employee Assistance Program), including working with systems, processes, and care partner accounts. 1-2 years of experience in coordinating, overseeing, and/or managing projects. Preferred Qualifications Strong cross-functional and departmental and collaboration skills. Strong decision making and solution-oriented skills. Excellent organization and time management skills. Ability to operate independently. Strong self-motivated nature. Familiarity with QuickBase navigation and basic building functionality. Previous experience working with Articulate. Education High school diploma or GED. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $46,988.00 - $122,400.00 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 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/benefits We anticipate the application window for this opening will close on: 12/26/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.