Compliance Professional 2
HumanaSalary not specified
- Full Time
- Junior (1 to 2 years)
$38,500 – $63,744Compensation
Junior (1 to 2 years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries
Requirements
Candidates should possess strong written and verbal communication skills, along with proficiency in basic computer skills including the Microsoft Office Suite. A high school diploma is preferred, and prior experience in appeals processes or clinical appeals is desirable.
Responsibilities
The Senior Coordinator, Complaints & Appeals Ops will support the daily processing of appeals in the Commercial Member Clinical Appeals (CMCA), completing appeals determination letters, intake and launching of expedited requests, updating systems, and completing reporting as necessary. They will also support the panel hearing process, triage faxes, move cases in the Complaints and Appeals Tracking System (CATS), and collaborate with clinical support staff such as Medical Directors, Nurses, and Providers. Furthermore, this role involves ensuring all work adheres to turnaround times and regulatory standards.
Skills
Written Communication
Verbal Communication
Multi-tasking
Microsoft Office Suite
CVS Health
Comprehensive pharmacy and healthcare services
About CVS Health
CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.
Woonsocket, Rhode IslandHeadquarters
1963Year Founded
DEBTCompany Stage
Healthcare, Consumer GoodsIndustries
10,001+Employees