Appeals & Grievance Specialist — Fast-Track Resolutions

CVS Health; Lexington (KY); On-site; USD 23,000 - 35,000; Full time

Benefits offered by this job

Medical, dental, and vision

Paid time off

Retirement plan

Job summary

CVS Health is seeking an Appeals, Complaints and Grievances Specialist to manage intake, investigations and resolutions across all products. You will coordinate with multiple business units to ensure accurate, timely responses to members and providers.

The role emphasizes research of benefit language, claim processing logic, and regulatory alignment, with a focus on high-paced, precise work and strong communication skills.

Qualifications

• Experience in reading or researching benefit language.
• 2–3 years experience in claim platforms, products, and benefits; patient management; product or contract drafting; compliance and regulatory analysis.
• Experience in customer service or audit is a plus.

Responsibilities

• Responsible for intake, investigation and resolution of appeals, complaints and grievances scenarios for all products, coordinating responses from multiple business units.
• Identify trends and emerging issues and report solutions.
• Coordinate final communication to member/provider for resolution and closure.
• Serve as a technical resource regarding appeals, complaints and grievance issues.
• Collaborate with other units to ensure accuracy and timely response.

Skills

Benefit language research

Regulatory analysis

Customer service

Audit experience

Education

Some college

High School or GED

Job description

CVS Health is seeking an Appeals, Complaints and Grievances Specialist to manage intake, investigations and resolutions across all products. You will coordinate with multiple business units to ensure accurate, timely responses to members and providers.

The role emphasizes research of benefit language, claim processing logic, and regulatory alignment, with a focus on high-paced, precise work and strong communication skills.