8,689 Issue Resolution jobs in the United States

APPEALS ISSUE RESOLUTION SPECIALIST

37247 Nashville, Tennessee State of Tennessee

Posted 3 days ago

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Job Description

Overview

Executive Service APPEALS ISSUE RESOLUTION SPECIALIST, Division of TennCare, Member Services, Nashville, TN

Salary: Minimum Monthly Salary $4,017/month - TennCare compensation is equitable and will be based on education and experience for a qualified candidate in accordance with Department of Human Resources (DOHR) policy.

Closing Date: 09/29/2025

The Division of TennCare is dedicated to providing our employees with a hybrid work environment. All TennCare positions have a combination of work from home and work in the office, which varies by position, department, and business need. You may review the specific expectations with our hiring team.

Background Check: This position requires a criminal background check. Therefore, you may be required to provide information about your criminal history in order to be considered for this position.

Who we are and what we do:

TennCare is Tennessee's managed care Medicaid program that provides health insurance coverage to certain groups of low-income individuals such as pregnant women, children, caretaker relatives of young children, older adults, and adults with physical disabilities. TennCare provides coverage for approximately 1.7 million Tennesseans and operates with an annual budget of approximately $14 billion. It is run by the Division of TennCare with oversight and some funding from the Centers for Medicare and Medicaid Services (CMS).

TennCare's mission is to improve the lives of Tennesseans by providing high-quality cost-effective care. To fulfill that purpose, we equip each employee for active participation and empower teams to communicate and worked collaboratively to improve organizational processes in order to make a difference in the lives our members. Because of the positive impact TennCare has on the lives of the most vulnerable Tennesseans, TennCare employees report that their work provides them with a sense of meaning, purpose, and accomplishment. TennCare leadership understands that employees are our most valuable resource and ensures professional and leadership development are a priority for the agency.

Job Overview

The Division of TennCare is seeking Appeals Issue Resolution Specialist for Appeals Operations Group within Member Services. The Appeals Issue Resolution Specialist will be responsible for providing support and guidance on matters relating to Medicaid rules, regulations, and policies. Additionally, this role will ensure that due process standards are met in Medicaid appeals by the accurate and timely processing of appeals and all appeals related documents. Finally, the Appeals Issue Resolution Specialist will also work collaboratively with management to identify workflow issues and accomplishments.

Key Responsibilities
  • Maintain a high-volume caseload and adhere to the timeliness standard of the AIR appeals while conducting the due process review.
  • Assist in the achievement of a high performing and positive work environment that will promote the TennCare Mission.
  • Receive and review appeals for potential resolution within policy guidelines daily. If resolution cannot be found, the coordinator moves the case forward in the appeal continuum for hearing.
  • Maintain case log to ensure all appeals are worked in the order received and follow up is timely is waiting for response from manager or other department.
  • Utilize case log to report daily productivity to manager.
  • Demonstrate attention to detail in researching appeal cases and documenting notes for proper case processing.
  • Attend and actively participate in all unit meetings and problem-solving discussions for workflow improvements.
Minimum Qualifications

Graduation from an accredited college or university with a bachelor's degree in a related field (preferred: business administration, management, public health, health policy, paralegal, or legal studies) and 2 years of relevant work experience; equivalent combination of education and experience may be considered.

OR

an equivalent combination of education and work experience may be considered.

Desirable Qualifications
  1. Graduation from an accredited college or university with a bachelor's degree, preferably in business administration, management, public health or health policy
  2. Four (4) years of experience within TennCare
  3. Four (4) years of experience within a Medicaid, managed care or healthcare organization.
  4. Ability to foster and maintain cohesive working relationships
  5. Ability to adapt to changing priorities and deadlines
  6. Ability to exercise sound judgment
  7. Strong organizational skills necessary, including the ability to prioritize, multi-task and manage workload to meet specific timeframes and deadlines
  8. Advanced writing and communication skills

Pursuant to the State of Tennessee's Workplace Discrimination and Harassment policy, the State is firmly committed to the principle of fair and equal employment opportunities for its citizens and strives to protect the rights and opportunities of all people to seek, obtain, and hold employment without being subjected to illegal discrimination and harassment in the workplace. It is the State's policy to provide an environment free of discrimination and harassment of an individual because of that person's race, color, national origin, age (40 and over), sex, pregnancy, religion, creed, disability, veteran's status or any other category protected by state and/or federal civil rights laws.

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Provider Digital Issue Research & Resolution Project Manager

78058 Pearsall, Texas CVS Health

Posted 4 days ago

Job Viewed

Tap Again To Close

Job Description

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

This role is for a position on the Issue Research and Resolution team within Provider Digital Operations organization. It involves support of our Digital Portal and provider electronic data interchange transactions. Main responsibilities include receiving issues directly from our Digital Portal users and internal customers, problem solving/troubleshooting, identification of appropriate systems based on the issue at hand, prioritization of issues and communicating complex technical details in a business-friendly manner understandable to our customers.

  • Maintain colleague access to the Digital Portal

  • Review colleague requests for portal access

  • Utilize reports to remove colleagues who no longer require access or have left the company.

  • Handle incoming support tickets related to Digital Portal functionality

  • Use knowledge of the Portal and Systems to determine whether the ticket is Portal-specific or not.

  • Respond to resolved tickets in a thoughtful, easily understandable way.

  • Send to EDI Consultants if issue requires more detailed Aetna system analysis or is not Portal-specific

  • Identify new/trending issues and share with manager for reporting purposes

  • Represent the Digital Portal during Aetna Immediate Response Team (IRT) issue calls

  • Act as liaison between the IRT and the Digital Portal team

  • Monitor Availity downtime/performance issues and share updates as they are available

  • Assist with communications related to the Digital Portal as needed

  • Represent the Digital Portal on the Intake & Digital Operations Work Intake Committee

  • Use knowledge of the Digital Portal during work request reviews to respond correctly for Digital Operations' involvement with the project/SR/Work request.

  • Support the Digital Portal Change Request (CR) process

  • Act as the liaison between the requester and the Digital Portal team

  • Share CR form with the requester

  • Meet with them to ensure form is sufficiently completed

  • Submit the form to the Digital Portal team

  • Schedule and facilitate bi-weekly CR Review meetings

  • Act as the single point of contact for Change Requests

  • Ensure that updates are shared with requesters

  • Obtain answers to questions on behalf of requesters and communicate the response back

Required Qualifications

  • Working knowledge of the provider Digital Portal

  • 2-4 years related work experience in the Provider Contact Center.

  • 2-4 years of EPDB experience

  • 1-3 years of EWM experience

  • 1-3 years of Salesforce/ GPS experience

  • Advanced skills in Outlook

Preferred Qualifications

  • 1-3 years of Service now experience

  • 3-5 years of experience in usage of EWM

  • 1-3 years of ACAS experience

  • 1-3 years of ICD-10, HCPCS, CPT experience

  • Exposure to AEPPAYS

  • Proficient use in Excel ?

Education

  • Bachelor's degree or equivalent experience of 2-4 years.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,300.00 - $159,120.00

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.

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

We anticipate the application window for this opening will close on: 10/31/2025

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.

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Provider Digital Issue Research & Resolution Project Manager

37803 Maryville, Tennessee CVS Health

Posted 4 days ago

Job Viewed

Tap Again To Close

Job Description

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

This role is for a position on the Issue Research and Resolution team within Provider Digital Operations organization. It involves support of our Digital Portal and provider electronic data interchange transactions. Main responsibilities include receiving issues directly from our Digital Portal users and internal customers, problem solving/troubleshooting, identification of appropriate systems based on the issue at hand, prioritization of issues and communicating complex technical details in a business-friendly manner understandable to our customers.

  • Maintain colleague access to the Digital Portal

  • Review colleague requests for portal access

  • Utilize reports to remove colleagues who no longer require access or have left the company.

  • Handle incoming support tickets related to Digital Portal functionality

  • Use knowledge of the Portal and Systems to determine whether the ticket is Portal-specific or not.

  • Respond to resolved tickets in a thoughtful, easily understandable way.

  • Send to EDI Consultants if issue requires more detailed Aetna system analysis or is not Portal-specific

  • Identify new/trending issues and share with manager for reporting purposes

  • Represent the Digital Portal during Aetna Immediate Response Team (IRT) issue calls

  • Act as liaison between the IRT and the Digital Portal team

  • Monitor Availity downtime/performance issues and share updates as they are available

  • Assist with communications related to the Digital Portal as needed

  • Represent the Digital Portal on the Intake & Digital Operations Work Intake Committee

  • Use knowledge of the Digital Portal during work request reviews to respond correctly for Digital Operations' involvement with the project/SR/Work request.

  • Support the Digital Portal Change Request (CR) process

  • Act as the liaison between the requester and the Digital Portal team

  • Share CR form with the requester

  • Meet with them to ensure form is sufficiently completed

  • Submit the form to the Digital Portal team

  • Schedule and facilitate bi-weekly CR Review meetings

  • Act as the single point of contact for Change Requests

  • Ensure that updates are shared with requesters

  • Obtain answers to questions on behalf of requesters and communicate the response back

Required Qualifications

  • Working knowledge of the provider Digital Portal

  • 2-4 years related work experience in the Provider Contact Center.

  • 2-4 years of EPDB experience

  • 1-3 years of EWM experience

  • 1-3 years of Salesforce/ GPS experience

  • Advanced skills in Outlook

Preferred Qualifications

  • 1-3 years of Service now experience

  • 3-5 years of experience in usage of EWM

  • 1-3 years of ACAS experience

  • 1-3 years of ICD-10, HCPCS, CPT experience

  • Exposure to AEPPAYS

  • Proficient use in Excel ?

Education

  • Bachelor's degree or equivalent experience of 2-4 years.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,300.00 - $159,120.00

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.

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

We anticipate the application window for this opening will close on: 10/31/2025

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.

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Provider Digital Issue Research & Resolution Project Manager

07070 Rutherford, New Jersey CVS Health

Posted 4 days ago

Job Viewed

Tap Again To Close

Job Description

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

This role is for a position on the Issue Research and Resolution team within Provider Digital Operations organization. It involves support of our Digital Portal and provider electronic data interchange transactions. Main responsibilities include receiving issues directly from our Digital Portal users and internal customers, problem solving/troubleshooting, identification of appropriate systems based on the issue at hand, prioritization of issues and communicating complex technical details in a business-friendly manner understandable to our customers.

  • Maintain colleague access to the Digital Portal

  • Review colleague requests for portal access

  • Utilize reports to remove colleagues who no longer require access or have left the company.

  • Handle incoming support tickets related to Digital Portal functionality

  • Use knowledge of the Portal and Systems to determine whether the ticket is Portal-specific or not.

  • Respond to resolved tickets in a thoughtful, easily understandable way.

  • Send to EDI Consultants if issue requires more detailed Aetna system analysis or is not Portal-specific

  • Identify new/trending issues and share with manager for reporting purposes

  • Represent the Digital Portal during Aetna Immediate Response Team (IRT) issue calls

  • Act as liaison between the IRT and the Digital Portal team

  • Monitor Availity downtime/performance issues and share updates as they are available

  • Assist with communications related to the Digital Portal as needed

  • Represent the Digital Portal on the Intake & Digital Operations Work Intake Committee

  • Use knowledge of the Digital Portal during work request reviews to respond correctly for Digital Operations' involvement with the project/SR/Work request.

  • Support the Digital Portal Change Request (CR) process

  • Act as the liaison between the requester and the Digital Portal team

  • Share CR form with the requester

  • Meet with them to ensure form is sufficiently completed

  • Submit the form to the Digital Portal team

  • Schedule and facilitate bi-weekly CR Review meetings

  • Act as the single point of contact for Change Requests

  • Ensure that updates are shared with requesters

  • Obtain answers to questions on behalf of requesters and communicate the response back

Required Qualifications

  • Working knowledge of the provider Digital Portal

  • 2-4 years related work experience in the Provider Contact Center.

  • 2-4 years of EPDB experience

  • 1-3 years of EWM experience

  • 1-3 years of Salesforce/ GPS experience

  • Advanced skills in Outlook

Preferred Qualifications

  • 1-3 years of Service now experience

  • 3-5 years of experience in usage of EWM

  • 1-3 years of ACAS experience

  • 1-3 years of ICD-10, HCPCS, CPT experience

  • Exposure to AEPPAYS

  • Proficient use in Excel ?

Education

  • Bachelor's degree or equivalent experience of 2-4 years.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,300.00 - $159,120.00

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.

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

We anticipate the application window for this opening will close on: 10/31/2025

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.

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Provider Digital Issue Research & Resolution Project Manager

29732 Rock Hill, South Carolina CVS Health

Posted 4 days ago

Job Viewed

Tap Again To Close

Job Description

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

This role is for a position on the Issue Research and Resolution team within Provider Digital Operations organization. It involves support of our Digital Portal and provider electronic data interchange transactions. Main responsibilities include receiving issues directly from our Digital Portal users and internal customers, problem solving/troubleshooting, identification of appropriate systems based on the issue at hand, prioritization of issues and communicating complex technical details in a business-friendly manner understandable to our customers.

  • Maintain colleague access to the Digital Portal

  • Review colleague requests for portal access

  • Utilize reports to remove colleagues who no longer require access or have left the company.

  • Handle incoming support tickets related to Digital Portal functionality

  • Use knowledge of the Portal and Systems to determine whether the ticket is Portal-specific or not.

  • Respond to resolved tickets in a thoughtful, easily understandable way.

  • Send to EDI Consultants if issue requires more detailed Aetna system analysis or is not Portal-specific

  • Identify new/trending issues and share with manager for reporting purposes

  • Represent the Digital Portal during Aetna Immediate Response Team (IRT) issue calls

  • Act as liaison between the IRT and the Digital Portal team

  • Monitor Availity downtime/performance issues and share updates as they are available

  • Assist with communications related to the Digital Portal as needed

  • Represent the Digital Portal on the Intake & Digital Operations Work Intake Committee

  • Use knowledge of the Digital Portal during work request reviews to respond correctly for Digital Operations' involvement with the project/SR/Work request.

  • Support the Digital Portal Change Request (CR) process

  • Act as the liaison between the requester and the Digital Portal team

  • Share CR form with the requester

  • Meet with them to ensure form is sufficiently completed

  • Submit the form to the Digital Portal team

  • Schedule and facilitate bi-weekly CR Review meetings

  • Act as the single point of contact for Change Requests

  • Ensure that updates are shared with requesters

  • Obtain answers to questions on behalf of requesters and communicate the response back

Required Qualifications

  • Working knowledge of the provider Digital Portal

  • 2-4 years related work experience in the Provider Contact Center.

  • 2-4 years of EPDB experience

  • 1-3 years of EWM experience

  • 1-3 years of Salesforce/ GPS experience

  • Advanced skills in Outlook

Preferred Qualifications

  • 1-3 years of Service now experience

  • 3-5 years of experience in usage of EWM

  • 1-3 years of ACAS experience

  • 1-3 years of ICD-10, HCPCS, CPT experience

  • Exposure to AEPPAYS

  • Proficient use in Excel ?

Education

  • Bachelor's degree or equivalent experience of 2-4 years.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,300.00 - $159,120.00

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.

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

We anticipate the application window for this opening will close on: 10/31/2025

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.

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Provider Digital Issue Research & Resolution Project Manager

10606 White Plains, New York CVS Health

Posted 5 days ago

Job Viewed

Tap Again To Close

Job Description

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

This role is for a position on the Issue Research and Resolution team within Provider Digital Operations organization. It involves support of our Digital Portal and provider electronic data interchange transactions. Main responsibilities include receiving issues directly from our Digital Portal users and internal customers, problem solving/troubleshooting, identification of appropriate systems based on the issue at hand, prioritization of issues and communicating complex technical details in a business-friendly manner understandable to our customers.

  • Maintain colleague access to the Digital Portal

  • Review colleague requests for portal access

  • Utilize reports to remove colleagues who no longer require access or have left the company.

  • Handle incoming support tickets related to Digital Portal functionality

  • Use knowledge of the Portal and Systems to determine whether the ticket is Portal-specific or not.

  • Respond to resolved tickets in a thoughtful, easily understandable way.

  • Send to EDI Consultants if issue requires more detailed Aetna system analysis or is not Portal-specific

  • Identify new/trending issues and share with manager for reporting purposes

  • Represent the Digital Portal during Aetna Immediate Response Team (IRT) issue calls

  • Act as liaison between the IRT and the Digital Portal team

  • Monitor Availity downtime/performance issues and share updates as they are available

  • Assist with communications related to the Digital Portal as needed

  • Represent the Digital Portal on the Intake & Digital Operations Work Intake Committee

  • Use knowledge of the Digital Portal during work request reviews to respond correctly for Digital Operations’ involvement with the project/SR/Work request.

  • Support the Digital Portal Change Request (CR) process

  • Act as the liaison between the requester and the Digital Portal team

  • Share CR form with the requester

  • Meet with them to ensure form is sufficiently completed

  • Submit the form to the Digital Portal team

  • Schedule and facilitate bi-weekly CR Review meetings

  • Act as the single point of contact for Change Requests

  • Ensure that updates are shared with requesters

  • Obtain answers to questions on behalf of requesters and communicate the response back

Required Qualifications

  • Working knowledge of the provider Digital Portal

  • 2-4 years related work experience in the Provider Contact Center.

  • 2-4 years of EPDB experience

  • 1-3 years of EWM experience

  • 1-3 years of Salesforce/ GPS experience

  • Advanced skills in Outlook

Preferred Qualifications

  • 1-3 years of Service now experience

  • 3-5 years of experience in usage of EWM

  • 1-3 years of ACAS experience

  • 1-3 years of ICD-10, HCPCS, CPT experience

  • Exposure to AEPPAYS

  • Proficient use in Excel

Education

  • Bachelor's degree or equivalent experience of 2-4 years.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,300.00 - $159,120.00

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.

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

We anticipate the application window for this opening will close on: 10/31/2025

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.

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Provider Digital Issue Research & Resolution Project Manager

Il, Illinois CVS Health

Posted 2 days ago

Job Viewed

Tap Again To Close

Job Description

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**
This role is for a position on the Issue Research and Resolution team within Provider Digital Operations organization. It involves support of our Digital Portal and provider electronic data interchange transactions. Main responsibilities include receiving issues directly from our Digital Portal users and internal customers, problem solving/troubleshooting, identification of appropriate systems based on the issue at hand, prioritization of issues and communicating complex technical details in a business-friendly manner understandable to our customers.
+ Maintain colleague access to the Digital Portal
+ Review colleague requests for portal access
+ Utilize reports to remove colleagues who no longer require access or have left the company.
+ Handle incoming support tickets related to Digital Portal functionality
+ Use knowledge of the Portal and Systems to determine whether the ticket is Portal-specific or not.
+ Respond to resolved tickets in a thoughtful, easily understandable way.
+ Send to EDI Consultants if issue requires more detailed Aetna system analysis or is not Portal-specific
+ Identify new/trending issues and share with manager for reporting purposes
+ Represent the Digital Portal during Aetna Immediate Response Team (IRT) issue calls
+ Act as liaison between the IRT and the Digital Portal team
+ Monitor Availity downtime/performance issues and share updates as they are available
+ Assist with communications related to the Digital Portal as needed
+ Represent the Digital Portal on the Intake & Digital Operations Work Intake Committee
+ Use knowledge of the Digital Portal during work request reviews to respond correctly for Digital Operations' involvement with the project/SR/Work request.
+ Support the Digital Portal Change Request (CR) process
+ Act as the liaison between the requester and the Digital Portal team
+ Share CR form with the requester
+ Meet with them to ensure form is sufficiently completed
+ Submit the form to the Digital Portal team
+ Schedule and facilitate bi-weekly CR Review meetings
+ Act as the single point of contact for Change Requests
+ Ensure that updates are shared with requesters
+ Obtain answers to questions on behalf of requesters and communicate the response back
**Required Qualifications**
+ Working knowledge of the provider Digital Portal
+ 2-4 years related work experience in the Provider Contact Center.
+ 2-4 years of EPDB experience
+ 1-3 years of EWM experience
+ 1-3 years of Salesforce/ GPS experience
+ Advanced skills in Outlook
**Preferred Qualifications**
+ 1-3 years of Service now experience
+ 3-5 years of experience in usage of EWM
+ 1-3 years of ACAS experience
+ 1-3 years of ICD-10, HCPCS, CPT experience
+ Exposure to AEPPAYS
+ Proficient use in Excel
**Education**
+ Bachelor's degree or equivalent experience of 2-4 years.
**Anticipated Weekly Hours**
40
**Time Type**
Full time
**Pay Range**
The typical pay range for this role is:
$54,300.00 - $159,120.00
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.
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 anticipate the application window for this opening will close on: 10/31/2025
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.
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Provider Digital Issue Research & Resolution Project Manager

Connecticut, Connecticut CVS Health

Posted 2 days ago

Job Viewed

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Job Description

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**
This role is for a position on the Issue Research and Resolution team within Provider Digital Operations organization. It involves support of our Digital Portal and provider electronic data interchange transactions. Main responsibilities include receiving issues directly from our Digital Portal users and internal customers, problem solving/troubleshooting, identification of appropriate systems based on the issue at hand, prioritization of issues and communicating complex technical details in a business-friendly manner understandable to our customers.
+ Maintain colleague access to the Digital Portal
+ Review colleague requests for portal access
+ Utilize reports to remove colleagues who no longer require access or have left the company.
+ Handle incoming support tickets related to Digital Portal functionality
+ Use knowledge of the Portal and Systems to determine whether the ticket is Portal-specific or not.
+ Respond to resolved tickets in a thoughtful, easily understandable way.
+ Send to EDI Consultants if issue requires more detailed Aetna system analysis or is not Portal-specific
+ Identify new/trending issues and share with manager for reporting purposes
+ Represent the Digital Portal during Aetna Immediate Response Team (IRT) issue calls
+ Act as liaison between the IRT and the Digital Portal team
+ Monitor Availity downtime/performance issues and share updates as they are available
+ Assist with communications related to the Digital Portal as needed
+ Represent the Digital Portal on the Intake & Digital Operations Work Intake Committee
+ Use knowledge of the Digital Portal during work request reviews to respond correctly for Digital Operations' involvement with the project/SR/Work request.
+ Support the Digital Portal Change Request (CR) process
+ Act as the liaison between the requester and the Digital Portal team
+ Share CR form with the requester
+ Meet with them to ensure form is sufficiently completed
+ Submit the form to the Digital Portal team
+ Schedule and facilitate bi-weekly CR Review meetings
+ Act as the single point of contact for Change Requests
+ Ensure that updates are shared with requesters
+ Obtain answers to questions on behalf of requesters and communicate the response back
**Required Qualifications**
+ Working knowledge of the provider Digital Portal
+ 2-4 years related work experience in the Provider Contact Center.
+ 2-4 years of EPDB experience
+ 1-3 years of EWM experience
+ 1-3 years of Salesforce/ GPS experience
+ Advanced skills in Outlook
**Preferred Qualifications**
+ 1-3 years of Service now experience
+ 3-5 years of experience in usage of EWM
+ 1-3 years of ACAS experience
+ 1-3 years of ICD-10, HCPCS, CPT experience
+ Exposure to AEPPAYS
+ Proficient use in Excel
**Education**
+ Bachelor's degree or equivalent experience of 2-4 years.
**Anticipated Weekly Hours**
40
**Time Type**
Full time
**Pay Range**
The typical pay range for this role is:
$54,300.00 - $159,120.00
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.
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 anticipate the application window for this opening will close on: 10/31/2025
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.
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Provider Digital Issue Research & Resolution Project Manager

Florida, Florida CVS Health

Posted 2 days ago

Job Viewed

Tap Again To Close

Job Description

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**
This role is for a position on the Issue Research and Resolution team within Provider Digital Operations organization. It involves support of our Digital Portal and provider electronic data interchange transactions. Main responsibilities include receiving issues directly from our Digital Portal users and internal customers, problem solving/troubleshooting, identification of appropriate systems based on the issue at hand, prioritization of issues and communicating complex technical details in a business-friendly manner understandable to our customers.
+ Maintain colleague access to the Digital Portal
+ Review colleague requests for portal access
+ Utilize reports to remove colleagues who no longer require access or have left the company.
+ Handle incoming support tickets related to Digital Portal functionality
+ Use knowledge of the Portal and Systems to determine whether the ticket is Portal-specific or not.
+ Respond to resolved tickets in a thoughtful, easily understandable way.
+ Send to EDI Consultants if issue requires more detailed Aetna system analysis or is not Portal-specific
+ Identify new/trending issues and share with manager for reporting purposes
+ Represent the Digital Portal during Aetna Immediate Response Team (IRT) issue calls
+ Act as liaison between the IRT and the Digital Portal team
+ Monitor Availity downtime/performance issues and share updates as they are available
+ Assist with communications related to the Digital Portal as needed
+ Represent the Digital Portal on the Intake & Digital Operations Work Intake Committee
+ Use knowledge of the Digital Portal during work request reviews to respond correctly for Digital Operations' involvement with the project/SR/Work request.
+ Support the Digital Portal Change Request (CR) process
+ Act as the liaison between the requester and the Digital Portal team
+ Share CR form with the requester
+ Meet with them to ensure form is sufficiently completed
+ Submit the form to the Digital Portal team
+ Schedule and facilitate bi-weekly CR Review meetings
+ Act as the single point of contact for Change Requests
+ Ensure that updates are shared with requesters
+ Obtain answers to questions on behalf of requesters and communicate the response back
**Required Qualifications**
+ Working knowledge of the provider Digital Portal
+ 2-4 years related work experience in the Provider Contact Center.
+ 2-4 years of EPDB experience
+ 1-3 years of EWM experience
+ 1-3 years of Salesforce/ GPS experience
+ Advanced skills in Outlook
**Preferred Qualifications**
+ 1-3 years of Service now experience
+ 3-5 years of experience in usage of EWM
+ 1-3 years of ACAS experience
+ 1-3 years of ICD-10, HCPCS, CPT experience
+ Exposure to AEPPAYS
+ Proficient use in Excel
**Education**
+ Bachelor's degree or equivalent experience of 2-4 years.
**Anticipated Weekly Hours**
40
**Time Type**
Full time
**Pay Range**
The typical pay range for this role is:
$54,300.00 - $159,120.00
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.
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 anticipate the application window for this opening will close on: 10/31/2025
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.
View Now

Provider Digital Issue Research & Resolution Project Manager

Arizona, Arizona CVS Health

Posted 2 days ago

Job Viewed

Tap Again To Close

Job Description

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**
This role is for a position on the Issue Research and Resolution team within Provider Digital Operations organization. It involves support of our Digital Portal and provider electronic data interchange transactions. Main responsibilities include receiving issues directly from our Digital Portal users and internal customers, problem solving/troubleshooting, identification of appropriate systems based on the issue at hand, prioritization of issues and communicating complex technical details in a business-friendly manner understandable to our customers.
+ Maintain colleague access to the Digital Portal
+ Review colleague requests for portal access
+ Utilize reports to remove colleagues who no longer require access or have left the company.
+ Handle incoming support tickets related to Digital Portal functionality
+ Use knowledge of the Portal and Systems to determine whether the ticket is Portal-specific or not.
+ Respond to resolved tickets in a thoughtful, easily understandable way.
+ Send to EDI Consultants if issue requires more detailed Aetna system analysis or is not Portal-specific
+ Identify new/trending issues and share with manager for reporting purposes
+ Represent the Digital Portal during Aetna Immediate Response Team (IRT) issue calls
+ Act as liaison between the IRT and the Digital Portal team
+ Monitor Availity downtime/performance issues and share updates as they are available
+ Assist with communications related to the Digital Portal as needed
+ Represent the Digital Portal on the Intake & Digital Operations Work Intake Committee
+ Use knowledge of the Digital Portal during work request reviews to respond correctly for Digital Operations' involvement with the project/SR/Work request.
+ Support the Digital Portal Change Request (CR) process
+ Act as the liaison between the requester and the Digital Portal team
+ Share CR form with the requester
+ Meet with them to ensure form is sufficiently completed
+ Submit the form to the Digital Portal team
+ Schedule and facilitate bi-weekly CR Review meetings
+ Act as the single point of contact for Change Requests
+ Ensure that updates are shared with requesters
+ Obtain answers to questions on behalf of requesters and communicate the response back
**Required Qualifications**
+ Working knowledge of the provider Digital Portal
+ 2-4 years related work experience in the Provider Contact Center.
+ 2-4 years of EPDB experience
+ 1-3 years of EWM experience
+ 1-3 years of Salesforce/ GPS experience
+ Advanced skills in Outlook
**Preferred Qualifications**
+ 1-3 years of Service now experience
+ 3-5 years of experience in usage of EWM
+ 1-3 years of ACAS experience
+ 1-3 years of ICD-10, HCPCS, CPT experience
+ Exposure to AEPPAYS
+ Proficient use in Excel
**Education**
+ Bachelor's degree or equivalent experience of 2-4 years.
**Anticipated Weekly Hours**
40
**Time Type**
Full time
**Pay Range**
The typical pay range for this role is:
$54,300.00 - $159,120.00
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.
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 anticipate the application window for this opening will close on: 10/31/2025
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.
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