Appeals & Grievance Specialist - Resolve & Improve Care

CVS Health; United States; Remote; USD 23,000 - 35,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

Paid time off

Job summary

CVS Health is looking for an Appeals Specialist to manage intake, investigation, and resolution of appeals, complaints, and grievances for all products. You will coordinate with multiple business units to ensure timely and customer-focused responses while identifying trends and potential improvements.

The role requires 1-2 years in claims platforms or related areas, strong analytical skills, and familiarity with benefit language.

Qualifications

• Experience reading or researching benefit language.
• 1-2 years experience across claim platforms, benefits, and customer service.
• Strong analytical and detail-oriented approach.

Responsibilities

• Research incoming electronic appeals and grievances for proper routing.
• Coordinate responses across multiple business units.
• Ensure timely, customer-focused resolution for appeals and complaints.
• Identify trends and report on potential solutions.
• Serve as a technical resource on appeals and grievance issues.

Skills

Benefit language reading

Claims processing experience

Regulatory/compliance knowledge

Education

Some college preferred

High School or GED

Job description

CVS Health is looking for an Appeals Specialist to manage intake, investigation, and resolution of appeals, complaints, and grievances for all products. You will coordinate with multiple business units to ensure timely and customer-focused responses while identifying trends and potential improvements.

The role requires 1-2 years in claims platforms or related areas, strong analytical skills, and familiarity with benefit language.