Appeals & Grievance Resolution Specialist

CVS Health; Oklahoma City (OK); On-site; USD 23,000 - 35,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking an Appeals Analyst to manage intake, investigation, and resolution of member appeals and grievances across products. The role requires coordinating responses across multiple units, identifying trends, and ensuring timely, customer-focused communication to members and providers.

Responsibilities include researching benefit language, claim processing logic, and eligibility data to ensure accurate resolutions.

Qualifications

• Experience reading or researching benefit language.
• 1-2 years experience in claims, benefits, customer service or audits.

Responsibilities

• Intake, investigate and resolve appeals and grievances.
• Coordinate responses from multiple units.
• Identify trends and report solutions.
• Reroute items not meeting criteria.
• Coordinate final communication to member/provider.
• Serve as a technical resource to colleagues.

Skills

Appeals processing

Data analysis

Regulatory understanding

Written communication

Problem solving

Education

Some college

High School Diploma or GED

Tools

Excel

Microsoft Word

Job description

CVS Health is seeking an Appeals Analyst to manage intake, investigation, and resolution of member appeals and grievances across products. The role requires coordinating responses across multiple units, identifying trends, and ensuring timely, customer-focused communication to members and providers.

Responsibilities include researching benefit language, claim processing logic, and eligibility data to ensure accurate resolutions.