Appeals & Grievance Resolution Specialist

CVS Health; New Jersey; Hybrid; USD 23,000 - 43,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Job summary

CVS Health is seeking an Appeals/Grievances Specialist to manage intake, investigation, and resolution of appeals, complaints, and grievances for all products. The role requires coordination across business units, analysis of benefit language, and timely, customer-focused responses to members and providers.

Responsibilities include researching plan design or coverage, validating claim processing logic, triaging components to SMEs, and serving as a technical resource for related issues.

Qualifications

• Experience reading or researching benefit language.
• 1-2 years experience with claim platforms, products, and benefits; patient management; drafting; compliance and regulatory analysis; investigations; provider relations; customer service or audit.

Responsibilities

• Handle intake, investigation, and resolution of appeals, complaints and grievances.
• Coordinate responses across multiple business units as needed.
• Identify trends in issues and report potential solutions.
• Provide technical guidance to colleagues on appeals and grievances.
• Ensure timely, customer-focused communication to members/providers.

Skills

Benefit language

Claims platforms

Customer service

Education

Some college

High School/GED

Tools

Excel

Microsoft Word

Job description

CVS Health is seeking an Appeals/Grievances Specialist to manage intake, investigation, and resolution of appeals, complaints, and grievances for all products. The role requires coordination across business units, analysis of benefit language, and timely, customer-focused responses to members and providers.

Responsibilities include researching plan design or coverage, validating claim processing logic, triaging components to SMEs, and serving as a technical resource for related issues.