Complaint and Appeals Senior Coordinator

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 The Senior Ops Coordinator reviews and processes appeals filed by participating providers, ensures adherence to regulatory requirements, and addresses compliance issues related to Complaint and Appeals policies. This role conducts internal audits, drafts appeal decision letters, and serves as a subject matter expert (SME) for complex cases. What you will do Review and process appeals filed by participating providers. Assist with adherence to regulatory requirements, conducts internal audits, and addresses any identified compliance issues with the Complaint and Appeals policies and procedures. Drafts and sends appeal decision letters. Provide peer support to coordinators when handling complex appeal issues. Serves as SME for handling complex cases such as CA IPA or SIU cases. Maintain successful performance for meeting monthly metrics for attendance, production and quality. Provide training and ongoing support to new hires to ensure successful onboarding and integration into team processes. Required Qualifications 2+ years in appeals, compliance, or a related coordination role Proven success in meeting monthly metrics for attendance, production and quality Strong knowledge of regulatory requirements and compliance standards Excellent written and verbal communication skills Ability to support and mentor peers on complex issues Proficiency with relevant software and case management tools Preferred Qualifications Medicare experience Claims experience Experience in reading or researching benefit language in Summary Plan...