Sr Coordinator Complaint Appeals Ops

Job Description Ability to work Silverscript PDP cases (Including MMR) independently Ability to work Aetna MAPD cases (including MMR) independently Serves as CTM Mentor on an as needed basis CTM Team SPOC CTM Special Projects Night Check ARNA Able to perform HPMS Download / Triage Progress from Full Case Review to Expedited Case Review Production - Aetna close 1.5 cases per day / Silverscript close 1.8 cases per dayPay RangeThe typical pay range for this role is:Minimum: 18.50Maximum: 33.65Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required QualificationsCTM Senior Coordinator QualificationsKnowledge of all MAPD CTM systems and productsStretch Assignments and Department Responsibilities:Has progressed from Expedited Case Review to Independent Case ReviewServes as CTM Case ReviewerServes as SPOC for high-touch members / providers Abiliy to works Allina Health casesAbility to works California IPA casesAbility to work Escalated Cases and participates in the Escalation workgroupExcellent Time management/Organization Mentor for peersExcellent oral and written communication skillsProduction - consistently closes 1.8 cases per dayLeadership Facilitates Team Huddle Leads / Participates in Team Building Initiatives Various Presentation / Facilitation assignmentsCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications General Medicare knowledge Prior experience with CTMs and/or Center for Medicaid and Medicare Services (CMS) Claim processing knowledge Ability to work flexible hours, some weekends and holidays. Overtime may be required during busy times of year.EducationBachelors or equivalent work experienceBusiness OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2025-11-01