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 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.

As a Complaints Tracking Module (CTM) Senior Coordinator, you will be part of the Medicare Complaints Tracking Module (CTM) Team, responsible for researching and resolving Medicare complaints received via the Centers for Medicaid and Medicare Services (CMS).

In this role, you will manage a queue of Medicare complaints. These complaints can include various issues ranging from claims that are adjudicated incorrectly to rude customer service.

You will be responsible for identifying the Medicare beneficiary’s complaint, researching Plan systems to identify the issue, partnering with other business departments to correct any potential issue, determining root cause, and bringing final resolution to the complaint. Resolution responses must be timely and include beneficiary focused solutions in both written and oral format. This is not a call center position, but you will be required to make outbound calls to both beneficiaries and providers to resolve their complaint. Department metrics are in place that include, but not limited to quality and productivity.

Preferred Qualifications

• Experience with Microsoft Office Suite, Word, Outlook and Excel

• General Medicare knowledge/experience

• Prior experience with complaints and/or Center for Medicare and Medicaid Services (CMS)

• Medical/RX claim processing knowledge

Required Qualifications

• Excellent communication skills, both verbal and oral

• Excellent problem-solving skills and critical thinking ability

• Time management skills

• Experience handling customer calls and elevated issues

• Ability to document resolution in written communication to beneficiaries 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 manage caseload effectively

• Ability to work flexible hours, some weekends and holidays.

• Overtime may be required during busy times of year

Education:

Bachelor’s degree or equivalent work experience

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$18.50 - $42.35

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 Benefits | CVS Health (https://jobs.cvshealth.com/us/en/benefits)

We anticipate the application window for this opening will close on: 02/19/2025

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

We are an equal opportunity and affirmative action employer. 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.