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

Location: CT - Work from home

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 communications.
• Strong communication and stakeholder management skills, with the ability to explain complex issues to diverse audiences.
• Demonstrated ability to support cross-functional initiatives, influence stakeholders, and drive results in a matrixed environment.
• Advanced proficiency in Microsoft Excel, PowerPoint, and data analysis/reporting tools.
• Ability to work independently, manage multiple priorities, and execute with minimal supervision.

Preferred Qualifications

• Proficiency with QuickBase or similar workflow management platforms
• Experience in Medicare Advantage, Part D, Commercial Appeals, Provider Appeals, Claims, Grievance, or CTM operations.
• Experience with governance, remediation tracking, root cause analysis, and operational improvement initiatives.
• Experience with reporting, analytics, automation, or business intelligence solutions.
• Experience supporting executive reporting and operational performance reviews.
• CAP, PMP, Lean Six Sigma, or related certification preferred.

Education

Bachelor's degree preferred or equivalent combination of education, professional experience, and relevant healthcare operational expertise.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is

$46,988.00 - $112,200.00

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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 10/23/2026

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