Appeals & Grievances Specialist

CVS Health; Baton Rouge (LA); On-site; USD 23,000 - 35,000; Full time

Benefits offered by this job

Medical coverage

Dental and vision coverage

Job summary

CVS Health is seeking a detail-oriented professional to manage intake, investigation and resolution of appeals, complaints, and grievances across products. You will coordinate responses from multiple teams, identify trends, and propose solutions while ensuring timely, customer-focused communications.

The role requires reading benefit language, researching claim processing logic, and applying current policies.

Qualifications

• 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.

Responsibilities

• Intake, investigate and resolve appeals, complaints and grievances across products.
• Coordinate responses from multiple business units to ensure timely resolution.
• Identify trends and report on emerging issues with recommended solutions.
• Research benefit language and verify claim processing logic for accuracy.
• Collaborate with colleagues as a technical resource on appeals and grievance matters.
• Meet tight turnaround times in a high-paced environment.
• Apply current policies and guidelines to decisions and communications.

Skills

Verbal communication

Written communication

Analytical skills

Attention to detail

Clinical terminology

Regulatory knowledge

Excel

Microsoft Word

Education

Some college preferred

High School or GED equivalent

Tools

Claim platforms

Regulatory analysis tools

Job description

CVS Health is seeking a detail-oriented professional to manage intake, investigation and resolution of appeals, complaints, and grievances across products. You will coordinate responses from multiple teams, identify trends, and propose solutions while ensuring timely, customer-focused communications.

The role requires reading benefit language, researching claim processing logic, and applying current policies.