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 in Oklahoma City is seeking an Appeals Analyst to handle intake, investigation, and resolution of appeals, complaints, and grievances across products. You will coordinate responses from multiple business units to ensure timely, customer-focused outcomes.

Responsibilities include researching benefit language and claim processing logic, triaging components to subject matter experts, and providing guidance on policies and regulatory requirements.

Qualifications

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

Responsibilities

• Research incoming appeals and grievances and route appropriately.
• Determine accuracy of benefit/administrative denial and claim processing logic.
• Coordinate resolution with multiple business units.
• Triage components to subject matter experts for final response content.
• Coordinate final communication to member/provider and closure.
• Serve as a technical resource on appeals and grievances.
• Identify trends and report on potential solutions.

Skills

Analytical skills

Verbal and written communication

Regulatory/compliance analysis

Education

High school diploma or GED

Some college

Tools

Excel

Microsoft Word

Job description

CVS Health in Oklahoma City is seeking an Appeals Analyst to handle intake, investigation, and resolution of appeals, complaints, and grievances across products. You will coordinate responses from multiple business units to ensure timely, customer-focused outcomes.

Responsibilities include researching benefit language and claim processing logic, triaging components to subject matter experts, and providing guidance on policies and regulatory requirements.