Appeals & Grievances Resolution Specialist

CVS Health; Louisiana; Híbrido; USD 23 000 - 35 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Medical insurance

Dental insurance

Vision insurance

Paid time off

Retirement savings

Resumo da oferta

CVS Health is seeking an Appeals, Complaints and Grievances Analyst to manage intake, investigations, and resolutions across products, coordinating responses with multiple units to ensure timely, customer-focused outcomes.

The role requires 1–2 years of experience with benefits, claims platforms, and regulatory analysis. Requires strong analytical skills and knowledge of plan design and regulatory requirements; full-time, 40 hours/week in Louisiana.

Qualificações

• Experience in reading or researching benefit language.
• 1-2 years experience that includes but is not limited to claim platforms, products, and benefits; patient management; product or contract drafting; compliance and regulatory analysis; special investigations; provider relations; customer service or audit experience.

Responsabilidades

• Handle intake, investigate and resolve appeals, complaints and grievances for all products.
• Coordinate responses across multiple units and ensure timely, customer-focused communication.
• Research plan design or certification of coverage to verify benefit accuracy.
• Review claim processing logic for accuracy of payments and eligibility before initiating appeal.
• Identify trends and escalate issues; collaborate with subject matter experts for final resolution content.

Conhecimentos

Customer service

Researching benefits

Analytical skills

Formação académica

Some college

High School or GED equivalent

Ferramentas

Excel

Microsoft Word

Descrição da oferta de emprego

CVS Health is seeking an Appeals, Complaints and Grievances Analyst to manage intake, investigations, and resolutions across products, coordinating responses with multiple units to ensure timely, customer-focused outcomes.

The role requires 1–2 years of experience with benefits, claims platforms, and regulatory analysis. Requires strong analytical skills and knowledge of plan design and regulatory requirements; full-time, 40 hours/week in Louisiana.