Appeals & Grievance Resolution Specialist

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

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking an Appeals Specialist in Oklahoma City to manage intake, investigation and resolution of appeals, complaints and grievances across products. You will coordinate responses from multiple units to deliver timely, member-focused outcomes and identify trends for improvements.

Research plan design, certification of coverage, and claim processing logic to ensure accurate determinations while collaborating with subject matter experts.

Qualifications

• Experience in reading or researching benefit language.
• 1-2 years experience including claim platforms, benefits, and customer service or audit experience.

Responsibilities

• Intake, investigation and resolution of appeals, complaints and grievances.
• Coordinate responses from multiple business units to ensure timely, customer-focused resolution.
• Research plan design or certification of coverage for accuracy of benefits.
• Review claim processing logic to verify payment, eligibility and status prior to appeal initiation.
• Identify and escalate trends and emerging issues; triage components to SMEs.
• Coordinate all components of appeals and provide final communication to member/provider.
• Serve as a technical resource on appeals and grievance issues.
• Maintain working knowledge of policies and regulatory requirements.
• Demonstrate strong written and verbal communication in a high-paced environment.

Skills

Benefit language research

Analytical skills

Attention to detail

Communication skills

Education

Some college

High School or GED

Tools

Excel

Microsoft Word

Job description

CVS Health is seeking an Appeals Specialist in Oklahoma City to manage intake, investigation and resolution of appeals, complaints and grievances across products. You will coordinate responses from multiple units to deliver timely, member-focused outcomes and identify trends for improvements.

Research plan design, certification of coverage, and claim processing logic to ensure accurate determinations while collaborating with subject matter experts.