We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

CVS Aetna is seeking a dedicated Senior Coordinator, Complaint and Appeals to join our remote team. In this role, you’ll play a critical role that supports the daily operations of the Commercial Member Clinical Appeals (CMCA) team.

 

Key Responsibilities

• Processing appeal determination letters, managing intake and expedited requests, updating internal systems, and generating reports.
• Supporting panel hearings and collaborating with clinical staff (Medical Directors, Nurses, Providers, etc.). (broke up the sentence into two bullets)
• Additional duties involve triaging incoming faxes and managing case movement within the Complaints and Appeals Tracking System (CATS).
• Completing tasks in accordance with regulatory standards and required turnaround times.
• This is a full-time telework position with standard hours of Monday–Friday, 8:00 AM to 5:00 PM (local time).
• Occasional weekend and holiday on-call coverage may be required.

 

Remote Work Expectations

• This is a 100% remote role; candidates must have a dedicated workspace free of interruptions.
• Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.

 

Required Qualifications

• Strong written and verbal communication skills.
• Ability to manage multiple tasks efficiently.
• Proficiency in Microsoft Office Suite and basic computer skills.

 

Preferred Qualifications

• 1–2 years of experience in healthcare appeals, grievances, or a related administrative role.
• 1+ year working in a healthcare setting (e.g., insurance, hospital administration, or clinical support)
• Experience with the appeals process or related work.

 

Education

• High School Diploma required.

Anticipated Weekly Hours

40

Time Type

Full time

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.  
 

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: 01/26/2026

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