Appeals & Grievance Specialist: Fast-Paced Impact

CVS Health; Central City (KY); On-site; USD 23,000 - 43,000; Full time

Job summary

CVS Health is seeking an Appeals and Grievances Specialist to manage intake, investigation, and resolution of member appeals, complaints, and grievances across plans. Responsibilities include routing items to correct teams, verifying claim processing and benefit language, and coordinating responses for timely, customer-focused outcomes.

The role requires strong analytical skills, knowledge of regulatory requirements, and proficiency with Excel and Word.

Qualifications

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

Responsibilities

• Intake, investigation and resolution of appeals, complaints and grievances.
• Coordinate responses from multiple business units for resolution content.
• Identify trends and report potential solutions.
• Serve as a technical resource to colleagues on appeals and grievance issues.
• Meet tight deadlines in a high-paced environment.

Tools

Excel

Microsoft Word

Job description

CVS Health is seeking an Appeals and Grievances Specialist to manage intake, investigation, and resolution of member appeals, complaints, and grievances across plans. Responsibilities include routing items to correct teams, verifying claim processing and benefit language, and coordinating responses for timely, customer-focused outcomes.

The role requires strong analytical skills, knowledge of regulatory requirements, and proficiency with Excel and Word.