Appeals & Grievances Specialist

CVS Health; United States; Remote; USD 23,000 - 43,000; Full time

Benefits offered by this job

Medical, Dental, Vision

Paid Time Off

Retirement Savings Plan

Career Development

Job summary

CVS Health in the United States is seeking an Appeals, Complaints and Grievances Specialist to manage intake, investigation and resolution for all products, coordinating with multiple business units to ensure timely, customer-focused responses.

You will research benefit language, plan design details and claim processing logic, identify trends and provide recommendations, while maintaining strong communication with members and providers.

Qualifications

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

Responsibilities

• Responsible for intake, investigation and resolution of appeals, complaints and grievances for all products, coordinating responses from multiple business units.
• Identify trends and emerging issues and report and recommend solutions.
• Serve as a technical resource to colleagues regarding appeals, complaints and grievance issues.

Skills

Benefit language

Regulatory analysis

Education

Some college preferred

High School Diploma or GED

Job description

CVS Health in the United States is seeking an Appeals, Complaints and Grievances Specialist to manage intake, investigation and resolution for all products, coordinating with multiple business units to ensure timely, customer-focused responses.

You will research benefit language, plan design details and claim processing logic, identify trends and provide recommendations, while maintaining strong communication with members and providers.