Senior Coordinator, Complaint and Appeals (Remote)
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. Position Summary CVS Aetna is seeking a dedicated Senior Coordinator, Complaint and Appeals to join our remote team. In this role, you’ll play a critical role that supports the daily operations of the Commercial Member Clinical Appeals (CMCA) team.
Key Responsibilities
- Processing appeal determination letters, managing intake and expedited requests, updating internal systems, and generating reports.
- Supporting panel hearings and collaborating with clinical staff (Medical Directors, Nurses, Providers, etc.). (broke up the sentence into two bullets)
- Additional duties involve triaging incoming faxes and managing case movement within the Complaints and Appeals Tracking System (CATS).
- Completing tasks in accordance with regulatory standards and required turnaround times.
- This is a full-time telework position with standard hours of Monday–Friday, 8:00 AM to 5:00 PM (local time).
- Occasional weekend and holiday on-call coverage may be required.
Remote Work Expectations
- This is a 100% remote role; candidates must have a dedicated workspace free of interruptions.
- Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.
Required Qualifications
- 1–2 years of experience in an administrative type role.
- Strong written and verbal communication skills.
- Ability to manage multiple tasks efficiently.
- Proficiency in Microsoft Office Suite and basic computer skills.
Preferred Qualifications
- 1–2 years of experience in healthcare appeals, grievances, or a related administrative role.
- 1+ year working in a healthcare setting (e.g., insurance, hospital administration, or clinical support)
- Experience with the appeals process or related work.
Education
- High School Diploma required.
Anticipated Weekly Hours 40 Time Type Full time Pay Range The Typical Pay Range For This Role Is $18.50 - $35.29 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. 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. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will close on: 05/01/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Apply tot his job Apply To this Job