At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

**Must live in Oklahoma**

Coordinate effective resolution of member or provider/practitioner appeals, complaints and grievances.

Establish and Maintain in collaboration with all segments and business units, consistent policies and procedures defining the administration and resolution of appeals, complaints and grievances from Aetna member and providers compliant with legislative, regulatory and accreditation requirements for all plans in the region. Maintain this infrastructure to assure ease of use and consistent resolution responses are accessible to all operational resolution teams and business units and subject matter experts.

-Manages and teams productivity and resources within the region, communicates productivity expectations and balances workload to achieve customer satisfaction through prompt/accurate handling of concerns.
-Manages a team of clinical and or non-clinical personnel.
-Serves as a content model expert and mentor to teams for each plan in the region in regards to Aetna's policies and procedures, regulatory and accreditation requirements.
-Manages to performance measures and standards for quality service and cost effectiveness and coaches individuals/team/region to take appropriate action.
-Select staff using clearly defined requirements in terms of education, experience, technical and performance skills.
-Build strong functional teams through formal training, diverse assignments, coaching, mentoring and other developmental techniques.
-Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing individuals, teams and the region.
-Ensures work of team meets federal and state requirements and quality measures, with respect to letter content and turn around time for appeals, complaints and grievances handling.
-Ensures all appeals, complaints and grievances units are utilizing the National tracking tool to ensure reporting consistency and trend analysis.
-Holds individuals/team accountable for results; recognize/reward as appropriate.
-Lead change efforts while managing transitions within a team.
-Identifies trends involving non-clinical & clinical issues and reports on and recommends solutions.
-Additional duties as assigned

Required Qualifications

3+ years supervisory experience.
3+ years appeals and greivences experience.

Preferred Qualifications

Experience in research and analysis of claim processing a plus.
Experience working with managed and non-managed health care benefits.

Education

Bachelor's degree or 5 years equivalent work experience in Healthcare, Project Management, Audit, Systems Design.

Pay Range

The typical pay range for this role is:

$67,900.00 - $149,328.00

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.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.  This position also includes an award target in the company’s equity award program. 
 

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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 09/21/2025

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