Appeals & Grievances Specialist

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

Benefits offered by this job

Comprehensive benefits package

Job summary

CVS Health is hiring for an Appeals Specialist responsible for intake, investigation and resolution of appeals, complaints and grievances across products. The role requires coordinating responses from multiple units, identifying issue trends, and ensuring timely, accurate member communications.

The position emphasizes strong analytical skills, knowledge of benefit terminology, and adherence to regulatory guidelines in a fast-paced environment.

Qualifications

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

Responsibilities

• Responsible for intake, investigation and resolution of appeals, complaints and grievances for all products and services.
• Coordinate responses from multiple business units as needed.
• Identify trends and emerging issues in appeals and grievances.
• Meet tight turnaround times and ensure accurate final communications to members/providers.

Skills

Benefit language research

Claims platforms experience

Regulatory analysis

Customer service

Education

Some college preferred

High School Diploma or GED

Job description

CVS Health is hiring for an Appeals Specialist responsible for intake, investigation and resolution of appeals, complaints and grievances across products. The role requires coordinating responses from multiple units, identifying issue trends, and ensuring timely, accurate member communications.

The position emphasizes strong analytical skills, knowledge of benefit terminology, and adherence to regulatory guidelines in a fast-paced environment.