Description

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 Coordinator, Complaints and Appeals is responsible for managing complex complaint and appeal cases to resolution for our Medicare line of business.

What you will do

• Evaluating complaint and appeal issues that may span multiple areas and coordinating responses across business units to ensure accurate and timely outcomes.
• Delivers customer focused resolutions while maintaining compliance with regulatory and internal standards.
• Analyzes trends, identifies emerging issues, and provides actionable recommendations to improve processes and prevent recurrence.

Remote Work Expectations

• Work Schedule: Monday-Friday 8:30am-5:00pm (Flex start times available after training)
• This is a 100% remote role within the US; 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

• Minimum of 1 year of experience involving Health Maintenance Organization (HMO) or experience with claim platforms, products, and benefits. Experience should include one or more of the following areas: patient management, compliance and regulatory analysis, special investigations, provider relations, customer service, claims processing, or audit functions.

Preferred Qualifications

• Experience with Medicare products and regulations
• Claims processing experience
• Ability to interpret and research benefit language within Summary Plan Descriptions and Certificates of Coverage
• Strong analytical skills with experience reviewing claim adjudication and identifying processing discrepancies

Education

• High school diploma or GED required

Anticipated Weekly Hours
40

Time Type
Full time

Pay Range

The typical pay range for this role is:

$18.50 - $31.72

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: 06/04/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.