Project Manager, Complaints & Appeals

CVS Health is hiring a Project Manager, Complaints & Appeals to lead and develop the Appeals team and oversee appeals projects. The role focuses on validating project effectiveness, improving processes, supporting staff development, and maintaining compliance with regulatory and accreditation requirements.

Responsibilities:

• Build and maintain a solid team through training, coaching and developing staff
• Validate effectiveness of the different projects managed by appeals team through universe data validation
• Facilitate and present at meetings within the Appeals team
• Establish and maintain in collaboration with the business, consistent processes defining the overview and readiness of appeals to help remain compliant with regulatory and accreditation requirements
• Assess developmental needs and collaborate with others to identify and implement action plans that support the development of high performing teams and individuals
• Manage projects and identify trends and recommends/acts on solutions
• Report capabilities related to audit requests and universe submissions

Requirements:

• 3+ years Appeals background
• Microsoft Office experience
• Knowledge of Appeals job aids/workflows
• Strong Communication skills - ability to provide and receive feedback
• Excellent time management skills
• 2+ years of supervisory experience
• Ability to work collaboratively across teams
• Strong analytical skills focusing on accuracy and attention to details
• High school diploma or higher education
• 2+ years Project Management experience
• QuickBase experience
• 2+ years training or leadership experience
• Knowledge of CMS guidance
• Product knowledge and experience with Appeals and Medicare Regulatory Requirements
• Appeals and MHK knowledge/experience
• Bachelor's degree or equivalent experience