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

Note: The job is a remote job and is open to candidates in USA. Aetna Resources, LLC is hiring a Senior Analyst to support its Root Cause Corrective Action program for the Claims, Grievances and Appeals leadership team. The role coordinates cross-functional issue resolution, root cause analysis, remediation tracking, governance, reporting, and process improvements to improve operational performance and member outcomes.

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

Skills

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

Benefits

• Eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range.
• Medical, dental, and vision coverage, based on eligibility.
• Paid time off, based on eligibility.
• Retirement savings options, based on eligibility.
• Wellness programs, based on eligibility.
• Remote/Hybrid work arrangement.

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