Appeals & Grievance Specialist

CVS Health; Trenton (NJ); On-site; USD 23,000 - 43,000; Full time

Job summary

CVS Health is seeking an Appeals, Complaints and Grievances Specialist to manage intake, investigation and resolution for all products. You will coordinate responses across multiple units, ensure timely, customer-focused outcomes and identify trends to improve processes.

Responsibilities include researching benefit language, verifying claim processing and determining eligibility, while collaborating with subject-matter experts to finalize resolutions.

Qualifications

• Experience reading or researching benefit language.
• 1–2 years experience across claim platforms, products and benefits; patient management; contract drafting; compliance and regulatory analysis; special investigations; provider relations; customer service or audit experience.
• Experience in research and analysis of claim processing is a plus.
• Experience with regulatory and accreditation requirements.

Responsibilities

• Investigate and resolve appeals, complaints and grievances across products.
• Coordinate responses from multiple business units for final resolution.
• Identify trends and report insights to improve processes.
• Serve as a technical resource on appeals and grievances to colleagues.
• Maintain thorough documentation and timely communication with members/providers.

Skills

Benefit language research

Customer service

Regulatory analysis

Provider relations

Audit experience

Education

Some college

HS/GED equivalent

Tools

Excel

Microsoft Word

Job description

CVS Health is seeking an Appeals, Complaints and Grievances Specialist to manage intake, investigation and resolution for all products. You will coordinate responses across multiple units, ensure timely, customer-focused outcomes and identify trends to improve processes.

Responsibilities include researching benefit language, verifying claim processing and determining eligibility, while collaborating with subject-matter experts to finalize resolutions.