Appeals & Grievance Resolution Specialist

CVS Health; Beryl (WV); On-site; USD 23,000 - 43,000; Full time

Benefits offered by this job

Medical, Dental, Vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a detail-oriented professional to manage intake, investigation, and resolution of appeals, complaints, and grievances across all products. You will verify benefit language, claim processing logic, and member eligibility data to ensure accurate, timely responses.

You will coordinate with multiple units, escalate for SME input as needed, and serve as a go-to resource on complex cases. Strong communication and regulatory knowledge are essential in this fast-paced role.

Qualifications

• Experience reading or researching benefit language.
• 1-2 years experience in claim platforms, products, benefits, or related areas.

Responsibilities

• Handle intake, investigation and resolution of appeals, complaints and grievances for all products.
• Research plan design, coverage relevant to member benefits and eligibility data.
• Verify claim processing logic and payment status prior to appeal initiation.
• Coordinate responses across multiple business units.
• Triage components to subject matter experts for final resolution content.
• Coordinate all components and final communication to member/provider.
• Serve as a technical resource for colleagues on appeals and grievance issues.
• Identify trends and report potential solutions.

Skills

Analytical skills

Verbal communication

Written communication

Clinical terminology

Regulatory knowledge

Excel

Microsoft Word

Education

Some college

High School or GED

Tools

Claim platforms

Job description

CVS Health is seeking a detail-oriented professional to manage intake, investigation, and resolution of appeals, complaints, and grievances across all products. You will verify benefit language, claim processing logic, and member eligibility data to ensure accurate, timely responses.

You will coordinate with multiple units, escalate for SME input as needed, and serve as a go-to resource on complex cases. Strong communication and regulatory knowledge are essential in this fast-paced role.