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 SummaryCVS 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.

• 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.

• 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.

• 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.

• High School Diploma required.