Senior Analyst, Complaints & Appeals (Project Management) - Remote

Before you apply

Job source

Workday

Applying on

cvshealth.wd1.myworkdayjobs.com

Workplace

Fully remote

US state

CT

Category

Project Management

Link last checked

2 hours ago

Posted

20 hours ago

Closes

No stated closing date

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About the role

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. The Senior Analyst, Project Management supports the Root Cause Corrective Action (RCCA) program by coordinating cross-functional issue resolution, supporting root cause analysis activities, tracking remediation efforts, and assessing operational and business impacts. This role partners closely with stakeholders across Claims, Grievances, Appeals, Compliance, Clinical, and Operational teams to identify recurring issue drivers, support governance activities, develop reporting and analytical solutions, and drive sustainable process improvements. Responsibilities include project coordination, stakeholder engagement, executive reporting, documentation management, and supporting leadership with data-driven recommendations that improve operational performance and member outcomes. The Senior Analyst Project Management role supports Claims, Grievances and Appeals leadership team. Primary Job Duties & Responsibilities: Applies in-depth knowledge to lead and manage cross-functional projects, ensuring successful planning, execution, and delivery within scope, timeline, and budget. Support the RCCA program by coordinating with issue stakeholders, monitoring remediation progress, and ensuring timely completion of corrective actions. Assist in root cause analysis activities, including issue identification, validation, trend analysis, corrective action planning, and development of recommendations to address recurring complaint, grievance, and appeal drivers. Partner with business stakeholders to quantify issue impact, analyze operational data, and support leadership reporting on risk, customer impact, and remediation outcomes. Support governance activities by validating root cause findings, tracking remediation effectiveness, and evaluating the sustainability of corrective actions. Identify operational defects, process gaps, compliance risks, and control weaknesses, and develop recommendations to improve quality, efficiency, and customer experience. Collaborate with cross-functional partners including Operations, Compliance, Clinical, Claims, Appeals, Provider/Network, Product, Technology, and Configuration teams to resolve issues and drive process improvements. Support projects and initiatives focused on process optimization, regulatory compliance, reporting enhancements, operational effectiveness, and reduction of recurring issue drivers. Develop and maintain process documentation, governance materials, job aids, training resources, and operational guidance to support program consistency and knowledge sharing. Assist with project planning, risk identification, milestone tracking, and stakeholder communications to ensure successful execution of RCCA-related initiatives. Monitor project and remediation activities, identify barriers to execution, escalate risks as needed, and provide regular status updates to leadership and stakeholders. Apply project management methodologies, governance standards, and continuous improvement practices to enhance program effectiveness and operational outcomes. Required Qualifications: 3-5 years of experience in healthcare operations Strong analytical, problem-solving, and critical thinking skills with experience in root cause analysis, trend analysis, and process improvement. Experience supporting governance programs, remediation tracking, issue management, and corrective action planning. Proven ability to analyze data, quantify business impact, and develop actionable recommendations. Experience creating executive-level reports, dashboards, presentations, and business communic

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