Supervisor Complaint Appeals
CVS Pharmacy - Philadelphia, PA
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Job DescriptionResponsible for the day-to-day management of staff to ensure effective resolution of member or provider/practitioner complaints/appeals. Responsible for organization and development of high performing teams to ensure timely, customer focused response to appeals. Facilitates effective interfaces among team members, as well as other business units. Responsible for implementation of Aetna/CVS Health's complaints and appeals policies and procedures. Manage control and trend inventory, independently investigate, change or revise policy to resolve the most escalated cases coming from broad, internal and external constituents for all products and issues. Accountable for meeting the financial, operational, and quality objectives of the unit. Attention to detail is needed and must be able to adapt to change due to routine regulatory updatesThis Supervisor will provide oversight to the Part C/Part B Preservice Expedited/Standard Appeal team.Through knowledge of the guidelines surrounding pre-service appeals is essential. Ability to provide focus on fast moving appeals is a must. Must have the ability to collaborate effectively with internal constituents to include Medical Directors, Nurses and different business partners who have an interest in appeals. Can troubleshoot problems and provide solutions to cases tasked to the team. Must be a great communicator when speaking to either the Medicare members or to the Appeals Team and Peers.Pay RangeThe typical pay range for this role is:Minimum: 40,560Maximum: 83,400Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required Qualifications-Ability to interpret and understand Regulatory Guidance, Member Contract Materials and have oversight over inventory which has strict and short time constraints. Fast paced environment.- 2+ years Leadership experience - Project Management- Colleague developmentPreferred Qualifications-Medicare Knowledge is a plusEducationBachelor's Degree or equivalent work experienceBusiness OverviewBring 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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
Created: 2024-09-07