Appeals & Grievances Specialist — Fast-Paced Resolution

CVS Health; Bastrop (LA); Sur place; USD 23 000 - 35 000; Plein temps

Avantages offerts par ce poste

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Résumé du poste

CVS Health is seeking an Appeals Specialist to manage intake, investigation, and resolution of appeals, complaints and grievances across products. You will coordinate responses from multiple units and ensure timely, customer-focused solutions.

The role requires research, attention to detail, and strong written and verbal communication, with familiarity with benefit language and regulatory expectations. A collaborative, fast-paced environment is typical.

Qualifications

• Experience in reading or researching benefit language.
• 1-2 years experience related to claim platforms, products, and benefits; patient management; provider relations; customer service or audits.

Responsabilités

• Intake, investigate and resolve appeals, complaints and grievances.
• Coordinate responses from multiple business units.
• Identify trends and report on potential solutions.
• Ensure timely, customer-focused response and final resolution.
• Act as a resource regarding appeals, complaints and grievance issues.
• Maintain knowledge of eligibility, benefits and regulatory guidelines.

Connaissances

Benefit language research

Analytical skills

Communication skills

Clinical terminology

Regulatory knowledge

Team collaboration

Research skills

Formation

Some college preferred

High School or GED

Outils

Excel

Microsoft Word

Description du poste

CVS Health is seeking an Appeals Specialist to manage intake, investigation, and resolution of appeals, complaints and grievances across products. You will coordinate responses from multiple units and ensure timely, customer-focused solutions.

The role requires research, attention to detail, and strong written and verbal communication, with familiarity with benefit language and regulatory expectations. A collaborative, fast-paced environment is typical.