CVS Health

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Senior Consultant Grievances Med D

at CVS Health

Posted: 3/27/2020
Job Reference #: 1223768BR

Job Description

Job Description
The Senior Grievance Consultant is a key role that will support over 6M Medicare Members.

As a Senior Grievance Consultant, you will be responsible for ensuring Grievance resolutions address member concerns and are in accordance with Centers of Medicare & Medicaid Services (CMS) guidelines.

This role is critical to ensuring high quality results, meeting department and CMS mandated TAT and mentoring Grievance Consultants.

As part of this role, you will be required to interact directly with clients and internal business partners. On a daily basis you will perform an end-to-end quality reviews of written grievances resolution letters and summaries that are drafted by the Grievance Consultants/caseworkers and provide feedback to ensure department and CMS required quality objectives are met. Additionally you will support the needs of the department in multiple audit functions (CMS Program Audit, client requested mock audits, and 3rd party generated audits) that are a direct result of the quality process.

Lastly, the Sr. Grievance Consultant will complete full root-cause analysis functions, providing process improvement recommendations across multiple internal business units, deliver interdepartmental training, with the goal of improving the member experience.

Required Qualifications
3+ years related work experience.

Preferred Qualifications
1+ year Medicare experience

High School diploma or equivalent, Bachelor's Degree preferred

Business Overview
It’s a new day in health care.

Combining CVS Health and Aetna was a transformative moment for our company and our industry, establishing CVS Health as the nation’s premier health innovation company. Through our health services, insurance plans and community pharmacists, we’re pioneering a bold new approach to total health. As a CVS Health colleague, you’ll be at the center of it all.

We offer a diverse work experience that empowers colleagues for career success. In addition to skill and experience, we also seek to attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability.

CVS Health is an equal opportunity/affirmative action employer. Gender/Ethnicity/Disability/Protected Veteran - we highly value and are committed to all forms of diversity in the workplace. 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. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT. We provide reasonable accommodations to qualified individuals with disabilities. If you require assistance to apply for this job, please contact our Advice and Counsel Reasonable Accommodations team. Please note that we only accept applications for employment via this site.

If technical issues are preventing you from applying to a position, contact Kenexa Helpdesk at 1-855-338-5609 or For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!