Appeals & Grievances Investigator

CVS Health; Oklahoma; On-site; USD 23,000 - 35,000; Full time

Benefits offered by this job

Medical insurance

Dental coverage

Vision coverage

Paid time off

Retirement savings

Job summary

CVS Health is seeking a dedicated Appeals, Complaints and Grievances specialist in the United States. The role focuses on intake, investigation, and resolution across products, coordinating with multiple business units to ensure timely, customer-friendly responses.

Required experience includes reading benefit language and 1–2 years in related areas; strong analytical skills and regulatory knowledge are essential. Excellent communication and Excel/Word proficiency are expected.

Qualifications

• Experience reading or researching benefit language.
• 1–2 years experience including claim platforms, benefits, or related areas.

Responsibilities

• Research incoming electronic appeals, complaints and grievance to determine appropriate routing.
• Research plan design or certification of coverage to verify benefit accuracy.
• Review claim processing logic for accuracy of payments and eligibility.
• Identify components of appeals and coordinate with SME for final content.
• Coordinate all components and communicate final response to member/provider.
• Serve as a technical resource on appeals and grievance issues.
• Identify trends and report on potential solutions.

Skills

Analytical skills

Verbal and written communication

Attention to detail

Regulatory knowledge

Collaboration

Computer literacy

Education

Some college

High School or GED

Tools

Excel

Microsoft Word

Job description

CVS Health is seeking a dedicated Appeals, Complaints and Grievances specialist in the United States. The role focuses on intake, investigation, and resolution across products, coordinating with multiple business units to ensure timely, customer-friendly responses.

Required experience includes reading benefit language and 1–2 years in related areas; strong analytical skills and regulatory knowledge are essential. Excellent communication and Excel/Word proficiency are expected.