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Sr Cdr, Complaint & Appeals Ops
Sr Cdr, Complaint & Appeals Ops-August 2024
Harrisburg
Aug 15, 2025
ABOUT CVS HEALTH
CVS Health is a healthcare innovation company. Together, we are helping people on their path to better health.
10,000+ employees
Healthcare
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About Sr Cdr, Complaint & Appeals Ops

  Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

  Position Summary This is a permanent work at home opportunity for candidates located in any state.At Aetna, a CVS Health Company, we are joined in a common purpose; helping people on their path to better health. We are working to transform healthcare through innovations that make quality care more accessible, easier to use, less expensive and patient focused.Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.We are committed to maintaining a diverse and inclusive work environment. CVS Health is an equal opportunity and affirmative action employer. WE do not discriminate in recruiting, hiring or promotion based on race ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience.The Medicare CTM Analyst will fully research and resolve beneficiary complaints submitted to the Centers for Medicaid and Medicare Services (CMS).These complaints can include various issues and may require coordination with various departments in order to fully reach resolution. Responses must be timely and include member focused solutions in both written and oral format.SO PIAB: Our Complaint & Appeals colleagues have opportunities to grow in and outside of our business unit with opportunities for advancement from a Provider Analyst to Member Analyst to Sr Analyst. There are paths to progression through our Skill Progression guide. We want to see you excel! " This role is a Hybrid role which means a hybrid Colleague works some of their scheduled workdays each week in an assigned company office location, and some workdays from a designated virtual work location, usually located in the Colleague's home ."Required Qualifications

  Customer Service skills• Experience handling customer service phone calls and elevated issues• Ability to document resolution in written communication to members in a professional and easy to understand manner• Experience troubleshooting complex customer problems• Attention to detail• Ability to work across various departments as necessary to establish the root cause and resolution of the issue• Ability to toggle between multiple applications• Ability to juggle caseload effectively

  Preferred Qualifications

  Customer Service skills• Experience handling customer service phone calls and elevated issues• Ability to document resolution in written communication to members in a professional and easy to understand manner• Experience troubleshooting complex customer problems• Attention to detail• Ability to work across various departments as necessary to establish the root cause and resolution of the issue• Ability to toggle between multiple applications• Ability to juggle caseload effectively

  Education

  The highest level of education desired for candidates is a bachelor’s degree or equivalent work experienceBusiness Overview

  Pay Range

  The typical pay range for this role is:

  $18.50 - $35.29

  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. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

  CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

  You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

  CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through [email protected] If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.

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