Appeals & Grievance Specialist

CVS Health; New York (NY); On-site; USD 23,000 - 43,000; Full time

Benefits offered by this job

Comprehensive benefits package

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a detail-oriented professional to manage appeals, complaints, and grievances. You will research benefit language, verify claim processing logic, and coordinate cross-unit responses to deliver accurate resolutions to members and providers.

The role requires 1-2 years of related experience, strong analytical and communication skills, and a customer-focused mindset. Full-time with comprehensive benefits offered.

Qualifications

• Experience reading or researching benefit language.
• 1-2 years experience including claim platforms, products, benefits, patient management, compliance and regulatory analysis.

Responsibilities

• Intake, investigate and resolve appeals, complaints and grievances across multiple products.
• Coordinate responses from multiple business units to ensure timely, customer-focused outcomes.
• Identify trends and communicate potential solutions to leadership.
• Serve as a technical resource for colleagues on appeals, complaints and grievance issues.
• Maintain accuracy and attention to detail in a fast-paced environment with tight deadlines.

Skills

Benefit language research

Claims processing knowledge

Regulatory analysis

Customer service experience

Education

Some college preferred

High School or GED equivalent

Tools

Excel

Microsoft Word

Job description

CVS Health is seeking a detail-oriented professional to manage appeals, complaints, and grievances. You will research benefit language, verify claim processing logic, and coordinate cross-unit responses to deliver accurate resolutions to members and providers.

The role requires 1-2 years of related experience, strong analytical and communication skills, and a customer-focused mindset. Full-time with comprehensive benefits offered.