Appeals & Grievances Specialist

CVS Health; Florida; Hybrid; 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 for all products. You will coordinate responses across units, identify trends and ensure timely, customer-focused resolutions.

Ideal candidates have 1-2 years in related areas, strong analytical and communication skills, and familiarity with claim processing and regulatory requirements. This full-time Florida role offers 40-hour weeks and comprehensive benefits.

Qualifications

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

Responsibilities

• Research incoming appeals, complaints and grievances to determine eligibility for unit routing.
• Research plan design or certification of coverage relevant to member benefits.
• Research claim processing logic to verify accuracy of payments, eligibility, and status.
• Identify and research all components within appeals for all products and services.
• Triage incomplete components to subject matter experts for resolution content.

Skills

Analytical skills

Verbal and written communication

Research abilities

Regulatory knowledge

Education

Some college

High School or GED

Tools

Excel

Microsoft Word

Job description

CVS Health is seeking an Appeals Specialist to manage intake, investigation and resolution of appeals, complaints and grievances for all products. You will coordinate responses across units, identify trends and ensure timely, customer-focused resolutions.

Ideal candidates have 1-2 years in related areas, strong analytical and communication skills, and familiarity with claim processing and regulatory requirements. This full-time Florida role offers 40-hour weeks and comprehensive benefits.