Appeals & Grievances Analyst

CVS Health; Yorktown (VA); On-site; USD 23,000 - 43,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking an Appeals Specialist to manage intake, investigation and resolution of appeals, complaints and grievances. You will coordinate responses across multiple business units and ensure timely, accurate, and customer-focused communications for each case.

The role requires researching benefit language, plan design and eligibility, with strong analytical and collaboration skills to identify trends and contribute to solutions. Full-time hours.

Qualifications

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

Responsibilities

• Intake, investigation and resolution of appeals, complaints and grievances across products.
• Coordinate responses from multiple business units and ensure timely, customer-focused communication.
• Research benefit language, plan design and eligibility to verify accuracy for final resolution.
• Identify trends and mentor others on escalation and content for final responses.

Skills

Analytical skills

Excellent verbal and written comms

Ability to work in high paced env

Cross-functional collaboration

Education

Some college preferred

High School or GED equivalent

Tools

Excel

Microsoft Word

Job description

CVS Health is seeking an Appeals Specialist to manage intake, investigation and resolution of appeals, complaints and grievances. You will coordinate responses across multiple business units and ensure timely, accurate, and customer-focused communications for each case.

The role requires researching benefit language, plan design and eligibility, with strong analytical and collaboration skills to identify trends and contribute to solutions. Full-time hours.