Top 410 Senior quality coordinator Jobs in Pennsylvania

Senior Coordinator, Complaint Appeals - Remote
CVS Health —Pennsylvania
- $18.50 - $35.29 an hour
- Full-time
- Remote
- Research
- Mid-level
- High school diploma or GED
- Health insurance
- Dental insurance
8d
Coordinator / Senior Coordinator, Project Services - Laboratories (Remote - East Coast)
IQVIA —Philadelphia, PA
- $44,500 - $111,800 a year
- Full-time
- Remote
- English
- Mid-level
- Microsoft Office
- Work from home
Associate Director for Curriculum Development & Online Education
University of Pennsylvania —Philadelphia, PA
- $80,891 - $96,500 a year
- Full-time
- Background check
- Master's degree
- University
- Health insurance
- Dental insurance
Quality Assurance Operational Integrity, Senior (Hybrid)- Located in Pittsburgh, PA
UPMC —Pittsburgh, PA
- $32.85 - $56.83 an hour
- Full-time
- Hybrid work
- Microsoft Excel
- Customer service
- Writing skills
- Health insurance
Resident Assessment Coordinator
Sunrise Senior Living —Haverford, PA
- $38.30 - $52.85 an hour
- Part-time
- Skilled nursing facility
- Mid-level
- LPN
- Paid holidays
- Health insurance
Registered Nurse (RN) Supervisor
Morningstar Living —Nazareth, PA
- From $41 an hour
- Part-time
- CPR Certification
- Nursing
- RN License
- Disability insurance
- Health insurance
Quick Apply
Human Resources Coordinator
Rosenberger North America —Akron, PA
- From $55,000 a year
- Full-time
- Microsoft Word
- Spanish
- Microsoft Excel
- Health savings account
- Health insurance
Quick Apply
8d
Logistics Coordinator
First Quaility McElhattan —McElhattan, PA
- Full-time
- Bachelor of Science
- Mid-level
- Office
- Wellness program
- Paid parental leave
Quick Apply
6d
Bilingual Community Coordinator (Homecare)
Penn Asian Senior Services —Philadelphia, PA
- $21 - $25 an hour
- Weekends as needed
- Travel
- Home Health
- US work authorization
- Health insurance
- Dental insurance
Quick Apply
4d
Memory Care Coordinator
Barclay Friends - A Kendal Affiliate —West Chester, PA
- Full-time
- Management
- Experience working with individuals with disabilities
- Mid-level
- 403(b) matching
- Health savings account
Quick Apply
13d
School Principal
Elwyn —Elwyn, PA
- $125,000 - $155,000 a year
- Overtime
- School experience
- Microsoft Excel
- Microsoft Outlook
- Paid training
- Health insurance
Quick Apply
6d
Assistant Location Manager
LEZZER LUMBER —Butler, PA
- Mid-level
- Bachelor's degree
- Warehouse
- Paid holidays
- Health insurance
Quick Apply
14d
Regional Director- Early Childhood Education
Catherine Hershey Schools —Hershey, PA
- Online Application
- Office
- Master's degree
- 8 years
Sr Engineer, Manufacturing
Fresenius Kabi —Warrendale, PA
- $85,000 - $95,000 a year
- Full-time
- English
- Senior level
- Leadership
- Wellness program
- Health insurance
Residential Homes Manager
Community Living & Support Services (CLASS) —Pittsburgh, PA
- $23.56 an hour
- Overtime
- Mid-level
- Office
- Residential
- Health savings account
- Disability insurance
Quick Apply
4d
US eCom/Retail – Marketing Coordinator
VINTAGE TUB & BATH —Mountain Top, PA
- From $45,000 a year
- Full-time
- Marketing
- Merchandising
- English
- Health insurance
- Dental insurance
Quick Apply
Assistant Resident Care Coordinator
Evergreen Estates Retirement Community —Lancaster, PA
- From $50,000 a year
- Full-time
- OSHA
- Computer literacy
- English
- Health insurance
- Dental insurance
Quick Apply
TSS Lead Coordinator
Penske Truck Leasing —Reading, PA
- Computer literacy
- Pass drug screening
- Mid-level
- Paid time off
4d
Direct Support Professional
Progressive Rehab Brain Injury Care —Milford, PA
- $15 - $17 an hour
- Overtime
- 18 years or older
- Experience working with individuals with disabilities
- Ability to walk for extended periods
Quick Apply
Activities Associate (Memory Care)- FT - Starting at $17/hour
Providence Place Senior Living —Collegeville, PA
- From $17 an hour
- Full-time
- Clean driving record
- High school diploma or GED
- Driver's License
Quick Apply
6d

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Senior Coordinator, Complaint Appeals - Remote

CVS Health -
Pennsylvania

Apply Now

Job Details

Full-time
$18.50 - $35.29 an hour
8 days ago

Benefits

Health insurance
Dental insurance
Paid time off
Vision insurance

Qualifications

Appeals
Medicare
Health insurance policy knowledge
Process design
Research
Case appeal in utilization management
Insurance claims appeal handling

Full Job Description

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.

Position Summary

Responsible for managing to resolution appeal scenarios for all products, which contain multiple issues and may require coordination of responses from multiple business units. Appeals are typically more complex and may require outreach and deviation from standard processes to complete. Develop into a subject matter expert by providing training, coaching, or responding to complex issues. May have contact with outside plan sponsors or regulators.

Research and resolves incoming electronic appeals as appropriate as a “single-point-of-contact” based on type of appeal.
Can identify and reroute inappropriate work items that do not meet complaint/appeal criteria as well as identify trends in misrouted work.
Assemble all data used in making denial determinations and can act as subject matter expert with regards to unit workflows, fiduciary responsibility and appeals processes and procedures.
Research standard plan design, certification of coverage and potential contractual deviations to determine the accuracy and appropriateness of a benefit/administrative denial.
Can review a clinical determination and understand rationale for decision.
Able to research claim processing logic and various systems to verify accuracy of claim payment, member eligibility data, billing/payment status, and prior to initiation of the appeal process.
Coordinates efforts both internally and across departments to successfully resolve claims research, SPD/COC interpretation, letter content, state or federal regulatory language, triaging of complaint/appeal issues, and similar situations requiring a higher level of expertise.
Identifies trends and emerging issues and reports on and gives input on potential solutions.
Delivers internal quality reviews, provides appropriate support in third party audits, customer meetings, regulatory meetings and consultant meetings when required.
Understands and can respond to Executive complaints and appeals, Department of Insurance, Department of Health or Attorney General complaints or appeals on behalf of members or providers as assigned.

Required Qualifications

1-2 years Medicare part C Appeals experience.
Experience in reading or researching benefit language in SPDs or COCs.
Experience in research and analysis of claim processing a plus.
Demonstrated ability to handle multiple assignments competently, accurately and efficiently.
Excellent verbal and written communication skills.
Excellent customer service skills.
Experience documenting workflows and reengineering efforts.

Preferred Qualifications

Strong knowledge of all case types including all specialty case types
Project management skills are preferred.

Education
High School Diploma

Anticipated Weekly Hours

Time Type

Full time

Pay Range

The typical pay range for this role is:

$18.50 - $35.29

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.

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: 07/24/2026

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

Apply Now

Refine Your Search

senior quality coordinator jobs in pennsylvania

Senior Coordinator, Complaint Appeals - Remote

Coordinator / Senior Coordinator, Project Services - Laboratories (Remote - East Coast)

Associate Director for Curriculum Development & Online Education

Quality Assurance Operational Integrity, Senior (Hybrid)- Located in Pittsburgh, PA

Resident Assessment Coordinator

Registered Nurse (RN) Supervisor

Human Resources Coordinator

Logistics Coordinator

Bilingual Community Coordinator (Homecare)

Memory Care Coordinator

School Principal

Assistant Location Manager

Regional Director- Early Childhood Education

Sr Engineer, Manufacturing

Residential Homes Manager

US eCom/Retail – Marketing Coordinator

Assistant Resident Care Coordinator

TSS Lead Coordinator

Direct Support Professional

Activities Associate (Memory Care)- FT - Starting at $17/hour

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