Senior Coordinator, Complaint and Appeals (Remote)
Hispanic Alliance for Career Enhancement, Lansing, MI, United States
Position Summary
CVS Aetna is seeking a dedicated
Senior Coordinator, Complaint and Appeals
to join our remote team. In this role, you will support the daily operations of the Commercial Member Clinical Appeals (CMCA) team, playing a critical role in ensuring that appeals and complaints are processed efficiently and accurately.
Key Responsibilities
Process appeal determination letters, manage intake and expedited requests, update internal systems, and generate reports.
Support panel hearings and collaborate with clinical staff (Medical Directors, Nurses, Providers, etc.).
Triage incoming faxes and manage case movement within the Complaints and Appeals Tracking System (CATS).
Complete tasks in accordance with regulatory standards and required turnaround times.
Perform this 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
Benefits
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.
EEO Statement
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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CVS Aetna is seeking a dedicated
Senior Coordinator, Complaint and Appeals
to join our remote team. In this role, you will support the daily operations of the Commercial Member Clinical Appeals (CMCA) team, playing a critical role in ensuring that appeals and complaints are processed efficiently and accurately.
Key Responsibilities
Process appeal determination letters, manage intake and expedited requests, update internal systems, and generate reports.
Support panel hearings and collaborate with clinical staff (Medical Directors, Nurses, Providers, etc.).
Triage incoming faxes and manage case movement within the Complaints and Appeals Tracking System (CATS).
Complete tasks in accordance with regulatory standards and required turnaround times.
Perform this 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
Benefits
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.
EEO Statement
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
#J-18808-Ljbffr